Comparison of novel hemostatic dressings with QuikClot combat gauze in a standardized swine model of uncontrolled hemorrhage

Jason M. Rall, Jennifer M. Cox, Adam G. Songer, Ramon F. Cestero, James Ross

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

BACKGROUND: Uncontrolled hemorrhage is the leading cause of preventable death on the battlefield. The development, testing, and application of novel hemostatic dressings may lead to a reduction of prehospital mortality through enhanced point-of-injury hemostatic control. This study aimed to determine the efficacy of currently available hemostatic dressings as compared with the current Committee for Tactical Combat Casualty Care Guidelines standard of treatment for hemorrhage control (QuikClot Combat Gauze [QCG]). METHODS: The femoral artery of anesthetized Yorkshire pigs was isolated and punctured. Free bleeding was allowed to proceed for 45 seconds before packing of QCG, QuikClot Combat Gauze XL (QCX), Celox Trauma Gauze (CTG), Celox Gauze (CEL), or HemCon ChitoGauze (HCG), into the wound. After 3 minutes of applied, direct pressure, fluid resuscitation was administered to elevate and maintain a mean arterial pressure of 60 mm Hg or greater during the 150-minute observation time. Animal survival, hemostasis, and blood loss were measured as primary end points. Hemodynamic and physiologic parameters, along with markers of coagulation, were recorded and analyzed. RESULTS: Sixty percent of QCG-treated animals (controls) survived through the 150-minute observation period. QCX, CEL, and HCG were observed to have higher rates of survival in comparison to QCG (70%, 90%, and 70% respectively), although these results were not found to be of statistical significance in pairwise comparison to QCG. Immediate hemostasis was achieved in 30% of QCG applications, 80% of QCX, 70% of CEL, 60% of HCG, and 30% of CTG-treated animals. Posttreatment blood loss varied from an average of 64 mL/kg with CTG to 29 mL/kg with CEL, but no significant difference among groups was observed. CONCLUSION: These results suggest that the novel hemostatic devices perform at least as well as the current Committee on Tactical Combat Casualty Care standard for point-of-injury hemorrhage control. Despite their different compositions and sizes, the lack of clear superiority of any agent suggests that contemporary hemostatic dressing technology has potentially reached a plateau for efficacy.

Original languageEnglish (US)
JournalJournal of Trauma and Acute Care Surgery
Volume75
Issue number2 SUPPL. 2
DOIs
StatePublished - Aug 2013
Externally publishedYes

Fingerprint

Hemostatics
Bandages
Swine
Hemorrhage
Wounds and Injuries
Standard of Care
Hemostasis
Observation
Femoral Artery
Celox
Resuscitation
Cause of Death
Arterial Pressure
Survival Rate
Hemodynamics
Guidelines
Technology
Pressure
Equipment and Supplies
Mortality

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Comparison of novel hemostatic dressings with QuikClot combat gauze in a standardized swine model of uncontrolled hemorrhage. / Rall, Jason M.; Cox, Jennifer M.; Songer, Adam G.; Cestero, Ramon F.; Ross, James.

In: Journal of Trauma and Acute Care Surgery, Vol. 75, No. 2 SUPPL. 2, 08.2013.

Research output: Contribution to journalArticle

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title = "Comparison of novel hemostatic dressings with QuikClot combat gauze in a standardized swine model of uncontrolled hemorrhage",
abstract = "BACKGROUND: Uncontrolled hemorrhage is the leading cause of preventable death on the battlefield. The development, testing, and application of novel hemostatic dressings may lead to a reduction of prehospital mortality through enhanced point-of-injury hemostatic control. This study aimed to determine the efficacy of currently available hemostatic dressings as compared with the current Committee for Tactical Combat Casualty Care Guidelines standard of treatment for hemorrhage control (QuikClot Combat Gauze [QCG]). METHODS: The femoral artery of anesthetized Yorkshire pigs was isolated and punctured. Free bleeding was allowed to proceed for 45 seconds before packing of QCG, QuikClot Combat Gauze XL (QCX), Celox Trauma Gauze (CTG), Celox Gauze (CEL), or HemCon ChitoGauze (HCG), into the wound. After 3 minutes of applied, direct pressure, fluid resuscitation was administered to elevate and maintain a mean arterial pressure of 60 mm Hg or greater during the 150-minute observation time. Animal survival, hemostasis, and blood loss were measured as primary end points. Hemodynamic and physiologic parameters, along with markers of coagulation, were recorded and analyzed. RESULTS: Sixty percent of QCG-treated animals (controls) survived through the 150-minute observation period. QCX, CEL, and HCG were observed to have higher rates of survival in comparison to QCG (70{\%}, 90{\%}, and 70{\%} respectively), although these results were not found to be of statistical significance in pairwise comparison to QCG. Immediate hemostasis was achieved in 30{\%} of QCG applications, 80{\%} of QCX, 70{\%} of CEL, 60{\%} of HCG, and 30{\%} of CTG-treated animals. Posttreatment blood loss varied from an average of 64 mL/kg with CTG to 29 mL/kg with CEL, but no significant difference among groups was observed. CONCLUSION: These results suggest that the novel hemostatic devices perform at least as well as the current Committee on Tactical Combat Casualty Care standard for point-of-injury hemorrhage control. Despite their different compositions and sizes, the lack of clear superiority of any agent suggests that contemporary hemostatic dressing technology has potentially reached a plateau for efficacy.",
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AU - Cestero, Ramon F.

AU - Ross, James

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N2 - BACKGROUND: Uncontrolled hemorrhage is the leading cause of preventable death on the battlefield. The development, testing, and application of novel hemostatic dressings may lead to a reduction of prehospital mortality through enhanced point-of-injury hemostatic control. This study aimed to determine the efficacy of currently available hemostatic dressings as compared with the current Committee for Tactical Combat Casualty Care Guidelines standard of treatment for hemorrhage control (QuikClot Combat Gauze [QCG]). METHODS: The femoral artery of anesthetized Yorkshire pigs was isolated and punctured. Free bleeding was allowed to proceed for 45 seconds before packing of QCG, QuikClot Combat Gauze XL (QCX), Celox Trauma Gauze (CTG), Celox Gauze (CEL), or HemCon ChitoGauze (HCG), into the wound. After 3 minutes of applied, direct pressure, fluid resuscitation was administered to elevate and maintain a mean arterial pressure of 60 mm Hg or greater during the 150-minute observation time. Animal survival, hemostasis, and blood loss were measured as primary end points. Hemodynamic and physiologic parameters, along with markers of coagulation, were recorded and analyzed. RESULTS: Sixty percent of QCG-treated animals (controls) survived through the 150-minute observation period. QCX, CEL, and HCG were observed to have higher rates of survival in comparison to QCG (70%, 90%, and 70% respectively), although these results were not found to be of statistical significance in pairwise comparison to QCG. Immediate hemostasis was achieved in 30% of QCG applications, 80% of QCX, 70% of CEL, 60% of HCG, and 30% of CTG-treated animals. Posttreatment blood loss varied from an average of 64 mL/kg with CTG to 29 mL/kg with CEL, but no significant difference among groups was observed. CONCLUSION: These results suggest that the novel hemostatic devices perform at least as well as the current Committee on Tactical Combat Casualty Care standard for point-of-injury hemorrhage control. Despite their different compositions and sizes, the lack of clear superiority of any agent suggests that contemporary hemostatic dressing technology has potentially reached a plateau for efficacy.

AB - BACKGROUND: Uncontrolled hemorrhage is the leading cause of preventable death on the battlefield. The development, testing, and application of novel hemostatic dressings may lead to a reduction of prehospital mortality through enhanced point-of-injury hemostatic control. This study aimed to determine the efficacy of currently available hemostatic dressings as compared with the current Committee for Tactical Combat Casualty Care Guidelines standard of treatment for hemorrhage control (QuikClot Combat Gauze [QCG]). METHODS: The femoral artery of anesthetized Yorkshire pigs was isolated and punctured. Free bleeding was allowed to proceed for 45 seconds before packing of QCG, QuikClot Combat Gauze XL (QCX), Celox Trauma Gauze (CTG), Celox Gauze (CEL), or HemCon ChitoGauze (HCG), into the wound. After 3 minutes of applied, direct pressure, fluid resuscitation was administered to elevate and maintain a mean arterial pressure of 60 mm Hg or greater during the 150-minute observation time. Animal survival, hemostasis, and blood loss were measured as primary end points. Hemodynamic and physiologic parameters, along with markers of coagulation, were recorded and analyzed. RESULTS: Sixty percent of QCG-treated animals (controls) survived through the 150-minute observation period. QCX, CEL, and HCG were observed to have higher rates of survival in comparison to QCG (70%, 90%, and 70% respectively), although these results were not found to be of statistical significance in pairwise comparison to QCG. Immediate hemostasis was achieved in 30% of QCG applications, 80% of QCX, 70% of CEL, 60% of HCG, and 30% of CTG-treated animals. Posttreatment blood loss varied from an average of 64 mL/kg with CTG to 29 mL/kg with CEL, but no significant difference among groups was observed. CONCLUSION: These results suggest that the novel hemostatic devices perform at least as well as the current Committee on Tactical Combat Casualty Care standard for point-of-injury hemorrhage control. Despite their different compositions and sizes, the lack of clear superiority of any agent suggests that contemporary hemostatic dressing technology has potentially reached a plateau for efficacy.

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