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Gerling KA, Kersey AJ, Lauria AL, Mares JA, Hutzler JD, White PW, Abel B, Burmeister DM, Propper B, White JM. Evaluation of novel hemostatic agents in a coagulopathic swine model of junctional hemorrhage. J Trauma Acute Care Surg 2023; 95:S144-S151. [PMID: 37259206 PMCID: PMC10389358 DOI: 10.1097/ta.0000000000004071] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Hemostatic dressings are used extensively in both military and civilian trauma to control lethal noncompressible hemorrhage. The ideal topical hemostatic agent would provide reliable hemostasis in patients with profound acidosis, coagulopathy, and shock. This study aimed to compare next-generation hemostatic agents against the current military standard in a translational swine model of vascular injury and coagulopathy. METHODS Female Yorkshire swine were randomized to eight groups (total n = 63; control n = 14, per group n = 7) of hemostatic agents and included: QuikClot Combat Gauze (Teleflex, Morrisville, NC), which served as the control; BloodSTOP IX (LifeScience Plus, Mountain View, CA); Celox Rapid (Medtrade Product, Crewe, United Kingdom); ChitoSAM 100 (Sam Medical, Tualatin, OR); EVARREST Fibrin Sealant Patch (Ethicon, Raritan, NJ); TAC Wrapping Gauze (H&H Medical, Williamsburg, VA); ChitoGauze XR Pro (Tricol Biomedical, Portland, OR); and X-Stat 30 (RevMedX, Wilsonville, OR). Hemodilution via exchange transfusion of 6% hetastarch was performed to induce acidosis and coagulopathy. An arteriotomy was created, allowing 30 seconds of free bleeding followed by application of the hemostatic agent and compression via an external compression device. A total of three applications were allowed for continued/recurrent bleeding. All blood loss was collected, and hemostatic agents were weighed to calculate blood volume loss. Following a 180-minute observation period, angiography was completed to evaluate for technical complication and distal perfusion of the limb. Finally, the limb was ranged five times to assess for rebleeding and clot stability. RESULTS All swine were confirmed coagulopathic with rotational thromboelastography and acidotic (pH 7.2 ± 0.02). BloodSTOP IX allowed a significant increase in blood loss and number of applications required to obtain hemostasis compared with all other groups. BloodSTOP IX demonstrated a decreased survival rate (29%, p = 0.02). All mortalities were directly attributed to exsanguination as a result of device failure. In surviving animals, there was no difference in extravasation. BloodSTOP IX had an increased rebleeding rate after ranging compared with QuikClot Combat Gauze ( p = 0.007). CONCLUSION Most novel hemostatic agents demonstrated comparable efficacy compared with the currently military standard hemostatic dressing, CG.
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Hafer A, Verga J, Sulava E, Friedrich E, Sheldon D, Boboc M, Bohan M, Norris E, Gaspary M, Stuart S. The evaluation of Hemoblast Bellows for arterial hemorrhage control in a swine model of vascular injury. TRAUMA-ENGLAND 2023. [DOI: 10.1177/14604086231152670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Background Uncontrolled hemorrhage remains the leading cause of preventable death on the battlefield. Hemostatic agents have increased in use and have been shown to improve survival. Combat Gauze (CG) is the most-used hemostatic gauze recommended by the Committee of Tactical Combat Casualty Care. Hemoblast Bellows (HB), a product FDA-approved for intraoperative hemorrhage, contains thrombin which differentiates it from CG and other kaolin-based hemostatic agents and has not been evaluated in the pre-hospital setting. This study aimed to compare HB to CG, in a standard swine arterial hemorrhage model. Methods Dilutional coagulopathy and hypothermia were induced in anesthetized Yorkshire-cross swine. The femoral artery was isolated and a 6 mm femoral arteriotomy was made. After a 30 s free bleed, randomly assigned hemostatic agent(s) from one of the three treatment groups: HB only, CG only, and HB + CG were applied and direct pressure was held for 3 min. At 30 min, the ipsilateral lower extremity was mobilized with a series of hip movements. Primary endpoints included blood loss, rebleeding, thromboelastogram (TEG) values, SPOT GRADE(TM) values, and mean arterial pressure (MAPs), which were monitored during the 150-min observation period. Results There were no significant differences between the treatment groups for blood loss, rebleeding, lactate, TEG values, SPOT GRADE, or MAPs for all time points examined. Conclusions We found no significant differences between the treatment groups for any of the included data points. These results suggest that arterial hemorrhage control with HB alone and HB + CG is not significantly different from hemorrhage control with CG only. These findings should not deter us from a continued investigation of hemostatic agents but should stimulate our search for superior hemorrhage control agents and novel delivery mechanisms. Continued innovation with such products may overcome the product limitations that we observed during testing and may prove to be a more relevant product for the point-of-injury.
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Affiliation(s)
- Ashley Hafer
- Department of Surgery, Naval Medical Center Portsmouth, Portsmouth, VA, USA
| | - Jared Verga
- Department of Emergency Medicine, Naval Medical Center Portsmouth, Portsmouth, VA, USA
| | - Eric Sulava
- Department of Emergency Medicine, Naval Medical Center Portsmouth, Portsmouth, VA, USA
| | | | - Diana Sheldon
- General Dynamics Information Technology, Fairfax, VA, USA
| | - Michael Boboc
- General Dynamics Information Technology, Fairfax, VA, USA
| | - Megan Bohan
- General Dynamics Information Technology, Fairfax, VA, USA
| | - Emily Norris
- Department of Surgery, Naval Medical Center Portsmouth, Portsmouth, VA, USA
| | - Micah Gaspary
- Department of Emergency Medicine, Naval Medical Center Portsmouth, Portsmouth, VA, USA
| | - Sean Stuart
- Department of Emergency Medicine, Naval Medical Center Portsmouth, Portsmouth, VA, USA
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Jamal L, Saini A, Quencer K, Altun I, Albadawi H, Khurana A, Naidu S, Patel I, Alzubaidi S, Oklu R. Emerging approaches to pre-hospital hemorrhage control: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1192. [PMID: 34430633 PMCID: PMC8350651 DOI: 10.21037/atm-20-5452] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 06/18/2021] [Indexed: 12/18/2022]
Abstract
In the United States, trauma claims the lives of over 150,000 civilians each year. In military settings, trauma and exsanguination result in 50% of combat related deaths. The majority of these deaths result from uncontrolled non-compressible hemorrhage. Non-compressible hemorrhage often results from deep vascular injuries within the torso, however can also occur secondary to penetrating injuries that involve the extremities. Given the high mortality rates for non-compressible hemorrhage, rapid and effective management of patients suffering from hemorrhage is essential to good patient outcomes. Consequently, there has been increasing interest in solutions for point-of-injury hemorrhage control in trauma and military medicine. Undoubtedly there is a great need for prehospital hemostatic interventions that can be deployed by trained and untrained personnel. Since 2001, various hemostatic agents have been developed, each with its advantages based upon the type and severity of injury, wound size, wound location, accessibility to injury site, and the coagulation status of the patient. These agents are often used in the military setting as a temporizing measure prior to definitive therapy and include techniques such as resuscitative endovascular balloon occlusion of the aorta (REBOA) and bioengineered agents including ResQFoam, RevMedx’s XSTAT, Tranexamic acid (TXA), and QuikClot Combat Gauze (QCG). Here, we review the indications, composition, technique, efficacy, and outcomes of these hemostatic agents.
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Affiliation(s)
- Leila Jamal
- Division of Vascular & Interventional Radiology, Laboratory for Patient Inspired Engineering, Mayo Clinic, Phoenix, AZ, USA
| | - Aman Saini
- Department of Radiology, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Keith Quencer
- Department of Radiology, University of Utah, Salt Lake City, Utah, USA
| | - Izzet Altun
- Division of Vascular & Interventional Radiology, Laboratory for Patient Inspired Engineering, Mayo Clinic, Phoenix, AZ, USA
| | - Hassan Albadawi
- Division of Vascular & Interventional Radiology, Laboratory for Patient Inspired Engineering, Mayo Clinic, Phoenix, AZ, USA
| | - Aditya Khurana
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA
| | - Sailendra Naidu
- Division of Vascular & Interventional Radiology, Laboratory for Patient Inspired Engineering, Mayo Clinic, Phoenix, AZ, USA
| | - Indravadan Patel
- Division of Vascular & Interventional Radiology, Laboratory for Patient Inspired Engineering, Mayo Clinic, Phoenix, AZ, USA
| | - Sadeer Alzubaidi
- Division of Vascular & Interventional Radiology, Laboratory for Patient Inspired Engineering, Mayo Clinic, Phoenix, AZ, USA
| | - Rahmi Oklu
- Division of Vascular & Interventional Radiology, Laboratory for Patient Inspired Engineering, Mayo Clinic, Phoenix, AZ, USA
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Pawel L, Dagmara GL, Pawel M, Bogumil R, Andrzej B, Sebastian S. Efficacy and safety of kaolin-based hemostatic pad vs. standard mechanical compression following transradial and transulnar access for elective coronary angiography and PCI: RAUL trial substudy. Heart Vessels 2019; 35:502-508. [PMID: 31655876 PMCID: PMC7085472 DOI: 10.1007/s00380-019-01520-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 10/02/2019] [Indexed: 01/09/2023]
Abstract
Hemostatic devices used in the transradial approach (TRA) and transulnar approach (TUA) are limited. This study compared the efficacy and safety of hemostasis using the QuikClot Radial hemostatic pad (QC) vs. standard mechanical compression (SC) after coronary angiography (CAG). This prospective single-center randomized trial included CAG patients. The primary and secondary endpoints were efficacy (successful hemostasis) and safety (total artery occlusion [TAO], pseudoaneurysm, hematoma), respectively. A visual analog scale (VAS) evaluated patient pain during compression. In 2013–2017, 200 patients were randomized 2 × 2 into the: (1) TRA and TUA groups and (2) QC and SC groups. Successful hemostasis was achieved in 92 (92%) patients in the QC group and 100 (100%) patients in the SC group (p < 0.006). The TRA SC subgroup showed significantly better results than the TRA QC subgroup (100% vs. 90.0%; p < 0.03). Similar results were obtained in the TUA QC and TUA SC subgroups (95% vs. 100%; p = 0.5). The secondary endpoint was achieved in the QC and SC groups (8% vs. 9%; p = 0.8). Patients reported significantly less pain during QC application than during SC (VAS: 2.6 ± 2.6 vs. 3.4 ± 2.9; p < 0.03). In patients undergoing CAG with TRA or TUA, QC was associated with lower efficacy, less discomfort, and similar safety compared to SC.
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Affiliation(s)
- Lewandowski Pawel
- Centre of Postgraduate Medical Education, Grochowski Hospital, Cardiology Department, Grenadierow 51/59, 04-073, Warsaw, Poland.
| | - Gralak-Lachowska Dagmara
- Centre of Postgraduate Medical Education, Grochowski Hospital, Cardiology Department, Grenadierow 51/59, 04-073, Warsaw, Poland
| | - Maciejewski Pawel
- Centre of Postgraduate Medical Education, Grochowski Hospital, Cardiology Department, Grenadierow 51/59, 04-073, Warsaw, Poland
| | - Ramotowski Bogumil
- Centre of Postgraduate Medical Education, Grochowski Hospital, Cardiology Department, Grenadierow 51/59, 04-073, Warsaw, Poland
| | - Budaj Andrzej
- Centre of Postgraduate Medical Education, Grochowski Hospital, Cardiology Department, Grenadierow 51/59, 04-073, Warsaw, Poland
| | - Stec Sebastian
- Chair of Electroradiology, Faculty of Medicine, University of Rzeszow, Rzeszow, Poland
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Noh JH, Lee JW, Nam YJ, Choi KY. Is Intraoperative Use of QuikClot Combat Gauze Effective for Hemostasis after Total Knee Arthroplasty? Clin Orthop Surg 2017; 9:43-49. [PMID: 28261426 PMCID: PMC5334026 DOI: 10.4055/cios.2017.9.1.43] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 10/11/2016] [Indexed: 11/29/2022] Open
Abstract
Background To assess the hemostatic effect of QuikClot Combat Gauze (QCG) compared to that of standard gauze during cruciate-retaining total knee arthroplasty (TKA). Methods Sixty knees underwent TKA using a pneumatic tourniquet in this prospective randomized study. After implantation of the femoral and tibial components and hardening of the bone cement, the tourniquet was deflated and QCG (group 1) or standard gauze (group 2) was packed into the joint cavity for 5 minutes for hemostasis. Perioperative bleeding volume and blood transfusion volume were compared between two groups. Results The mean intraoperative bleeding volume was 64.7 ± 12.7 mL in group 1 and 63.9 ± 9.2 mL in group 2 (p = 0.808). The mean postoperative blood drainage was 349.0 ± 170.6 mL in group 1 and 270.1 ± 136.3 mL in group 2 (p = 0.057). The average postoperative blood transfusion volume was 323.7 ± 325.9 mL in group 1 and 403.6 ± 274.8 mL in group 2 (p = 0.314). Conclusions QCG was not significantly effective for reducing perioperative bleeding volume or the blood transfusion rate compared with standard gauze during TKA.
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Affiliation(s)
- Jung Ho Noh
- Department of Orthopaedic Surgery, Kangwon National University Hospital, Chuncheon, Korea
| | - Jae Woo Lee
- Department of Orthopaedic Surgery, Kangwon National University Hospital, Chuncheon, Korea
| | - Young Joon Nam
- Department of Orthopaedic Surgery, Kangwon National University Hospital, Chuncheon, Korea
| | - Ki Yong Choi
- Department of Orthopaedic Surgery, Kangwon National University Hospital, Chuncheon, Korea
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Qian Z, Wang H, Tuo X, Guo H, Xu P, Liu D, Wei Y, Liu H, Fan Y, Guo X. A porous sodium polyacrylate-grafted chitosan xerogel for severe hemorrhage control synthesized from one-pot reaction. J Mater Chem B 2017; 5:4845-4851. [PMID: 32264000 DOI: 10.1039/c7tb00802c] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In this study, we fabricated a SPA-co-CTS sponge and demonstrated a fast and powerful hemostatic effect bothin vitroandin vivo, which was a promising first-aid device for severe hemorrhage control.
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Affiliation(s)
- Zhiyong Qian
- School of Biological Science and Medical Engineering
- Beihang University
- Beijing
- China
- Department of Advanced Interdisciplinary Studies
| | - Haiping Wang
- Department of Transfusion
- 307 Hospital of Chinese PLA
- Beijing
- P. R. China
| | - Xiaoye Tuo
- Department of Burns and Plastic Surgery
- First Affiliated Hospital of PLA General Hospital
- Beijing
- P. R. China
| | - Hongyan Guo
- Stomatology Center
- General Hospital of Armed Police Forces
- Beijing
- P. R. China
| | - Peng Xu
- Stomatology Center
- General Hospital of Armed Police Forces
- Beijing
- P. R. China
| | - Donghua Liu
- Department of Advanced Interdisciplinary Studies
- Institute of Basic Medical Sciences
- Beijing
- P. R. China
| | - Yen Wei
- Department of Chemistry
- Tsinghua University
- Beijing
- P. R. China
| | - Haifeng Liu
- School of Biological Science and Medical Engineering
- Beihang University
- Beijing
- China
| | - Yubo Fan
- School of Biological Science and Medical Engineering
- Beihang University
- Beijing
- China
| | - Ximin Guo
- Department of Advanced Interdisciplinary Studies
- Institute of Basic Medical Sciences
- Beijing
- P. R. China
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