New hemostatic agents in the combat setting

E. Darrin Cox, Martin Schreiber, John McManus, Charles E. Wade, John B. Holcomb

    Research output: Contribution to journalArticle

    81 Citations (Scopus)

    Abstract

    Hemorrhage is a leading cause of potentially preventable death in both civilian and military trauma patients. Animal data have shown that hemostatic bandages reduce hemorrhage and improve survival. This article reports recent clinical observations regarding the efficacy and evolution of use of two new hemostatic bandages employed in the global war on terrorism. METHODS: We performed a retrospective cohort review of soldiers treated with either the QuikClot or HemCon hemostatic bandages between April and October 2006. Hemostatic dressings were placed on wounds either in the field or at the combat support hospital (CSH). RESULTS: During the 6-month study period, 1691 trauma patients were admitted to the CSH. Fifty uses of hemostatic dressings in 44 patients (2.6% of admissions) were identified. Forty patients were treated with HemCon dressings, three patients with QuikClot, and one with both QuikClot and HemCon. Eighteen percent of the dressings were used in the field, predominantly on extremity wounds (78). In contrast, most dressings used in the CSH were for truncal wounds (2636 patients). Hemostatic dressings were applied to extremity wounds in prehospital and hospital settings, either alone or in conjunction with tourniquets. In surviving patients (95%), the treating surgeon determined that the hemorrhage was either stopped or greatly decreased by use of hemostatic dressings. Two of the four patients treated with QuikClot had burns from exothermic reactions, while no adverse reactions were noted with HemCon. CONCLUSIONS: Hemostatic agents stop or decrease bleeding. Whereas HemCon appears to be safe, QuikClot may produce superficial burns. These new hemostatic agents have a place in the surgical armamentarium to assist in controlling internal hemorrhage from truncal and pelvic hemorrhage, especially during damage-control surgery.

    Original languageEnglish (US)
    JournalTransfusion
    Volume49
    Issue numberSUPPL.5
    DOIs
    StatePublished - Dec 2009

    Fingerprint

    Hemostatics
    Bandages
    Hemorrhage
    Wounds and Injuries
    Burns
    Extremities
    Terrorism
    Tourniquets
    Patient Admission
    Military Personnel
    Survival

    ASJC Scopus subject areas

    • Hematology
    • Immunology
    • Immunology and Allergy

    Cite this

    Cox, E. D., Schreiber, M., McManus, J., Wade, C. E., & Holcomb, J. B. (2009). New hemostatic agents in the combat setting. Transfusion, 49(SUPPL.5). https://doi.org/10.1111/j.1537-2995.2008.01988.x

    New hemostatic agents in the combat setting. / Cox, E. Darrin; Schreiber, Martin; McManus, John; Wade, Charles E.; Holcomb, John B.

    In: Transfusion, Vol. 49, No. SUPPL.5, 12.2009.

    Research output: Contribution to journalArticle

    Cox, ED, Schreiber, M, McManus, J, Wade, CE & Holcomb, JB 2009, 'New hemostatic agents in the combat setting', Transfusion, vol. 49, no. SUPPL.5. https://doi.org/10.1111/j.1537-2995.2008.01988.x
    Cox, E. Darrin ; Schreiber, Martin ; McManus, John ; Wade, Charles E. ; Holcomb, John B. / New hemostatic agents in the combat setting. In: Transfusion. 2009 ; Vol. 49, No. SUPPL.5.
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    abstract = "Hemorrhage is a leading cause of potentially preventable death in both civilian and military trauma patients. Animal data have shown that hemostatic bandages reduce hemorrhage and improve survival. This article reports recent clinical observations regarding the efficacy and evolution of use of two new hemostatic bandages employed in the global war on terrorism. METHODS: We performed a retrospective cohort review of soldiers treated with either the QuikClot or HemCon hemostatic bandages between April and October 2006. Hemostatic dressings were placed on wounds either in the field or at the combat support hospital (CSH). RESULTS: During the 6-month study period, 1691 trauma patients were admitted to the CSH. Fifty uses of hemostatic dressings in 44 patients (2.6{\%} of admissions) were identified. Forty patients were treated with HemCon dressings, three patients with QuikClot, and one with both QuikClot and HemCon. Eighteen percent of the dressings were used in the field, predominantly on extremity wounds (78). In contrast, most dressings used in the CSH were for truncal wounds (2636 patients). Hemostatic dressings were applied to extremity wounds in prehospital and hospital settings, either alone or in conjunction with tourniquets. In surviving patients (95{\%}), the treating surgeon determined that the hemorrhage was either stopped or greatly decreased by use of hemostatic dressings. Two of the four patients treated with QuikClot had burns from exothermic reactions, while no adverse reactions were noted with HemCon. CONCLUSIONS: Hemostatic agents stop or decrease bleeding. Whereas HemCon appears to be safe, QuikClot may produce superficial burns. These new hemostatic agents have a place in the surgical armamentarium to assist in controlling internal hemorrhage from truncal and pelvic hemorrhage, especially during damage-control surgery.",
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