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EM in Ireland’s involvement in CRASH 3

The Emergency Medicine community in Ireland has collaborated in a major international trial, showing that a simple and cheap intervention in head injury can save hundreds of thousands of lives globally.

Medical staff at Cork University Hospital, working with the HRB Clinical Research Facility at University College Cork, have helped prove the role of a low cost widely available drug in reducing deaths in certain groups of traumatic brain injury patients by as much as 20% as reported in The Lancet. The research shows that tranexamic acid (TXA), can save hundreds of thousands of lives by reducing post-traumatic bleeding into the brain.

Led by the London School of Hygiene & Tropical Medicine, the global trial examined 12,000 head injury patients. It found that administration of TXA within three hours of injury reduced the number of deaths, mostly in in patients with mild and moderate traumatic brain injury, by up to 20%. Importantly, the study found no evidence of adverse effects nor increase in disability in survivors who were given TXA.

Traumatic brain injury (TBI) is a leading cause of death and disability, with an estimated 69 million new cases each year worldwide. The CRASH-3  trial is one of the largest clinical trials ever conducted into head injury. Dr Conor Deasy, Principal Investigator at Cork University Hospital, states “Traumatic head injury can happen to anyone with a risk of devastating consequences. Administration of tranexamic acid is known to save lives in patients with bleeding in the chest or abdomen. This paper shows that early treatment with TXA also reduces deaths from head injury. The study showed a 10% reduction in treatment effectiveness for every 20-minute delay, meaning that patients should be treated with TXA as soon as possible after head injury’’.

Dr Emily O’ Conor, President of the Irish Association for Emergency Medicine, especially acknowledged the patients and their families who were recruited to this trial and the work of staff, particularly those in Emergency, Intensive Care and Neurosurgery Departments at Cork University Hospital. She notes: ‘trials such as these are difficult to plan and perform, to ensure the conclusion is accurate. On arrival to the Emergency Department very sick or injured and in distress, being asked if you or your loved one would be willing to be recruited to a trial could be challenging, confusing and upsetting, but the outcomes of such trials are vital in identifying lifesaving interventions’.

This was a trial jointly funded by the Department for International Development (DFID), the Medical Research Council (MRC), the National Institute for Health Research (NIHR), (through the Department of Health and Social Care), and Wellcome. The early phase of the trial was funded by The JP Moulton Charitable Foundation. Hospitals including Cork University Hospital or UCC staff or patients did not receive funding to take part.


The CRASH-3 trial collaborators, Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trialThe Lancet. DOI: 10.1016/ S0140-6736(19)32233-0

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