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The effects of QuikClot Combat Gauze on hemorrhage control when used in a porcine model of lethal femoral injury

Don Johnson, PhD, Douglas M. Westbrook Jr, BSN, Deanna Phelps, BSN, Jose Blanco, MD, Michael Bentley, CRNA, PhD, James Burgert, CRNA, DNAP, Brian Gegel, CRNA, DNAP

Abstract


Objectives: The aims of the study were to 1) determine the effectiveness of QuikClot Combat Gauze (QCG); 2) determine the arterial blood pressure at which rebleeding occurs; 3) determine how much intravenous fluid could be administered before hemorrhage reoccurred, and 4) determine the number extremity movement on rebleeding when QCG was used.

Design: This was a prospective, randomized, experimental study.

Subjects: Adult Yorkshire pigs were randomly assigned to two groups QCG (n = 10) or control (n = 10).

Intervention: After the swine were anesthetized, the investigators transected the femoral artery and vein. After 1 minute of uncontrolled bleeding, QCG was placed in the wound followed by standard wound packing. The control group underwent the same procedures without QCG. After 5 minutes of firm, manual pressure, a pressure dressing was applied. Following 30 minutes, the dressings were removed and blood loss was calculated. If hemostasis occurred, phenylephrine was administered until there was rebleeding. If no bleeding, up to 5 L of IV crystalloid was administered until there was hemorrhage. If no bleeding, the extremity on the side of the hemorrhage was moved through flexion, extension, abduction, and adduction 10 times or until rebleeding occurred.

Main outcomes: QCG compared to a control was more effective in controlling hemorrhage, withstanding increases in systolic blood pressure, more latitude in resuscitation fluid, and movement (p < 0.05).


Keywords


hemorrhage control, QuikClot hemostatic agent, hemostatic agents

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References


Lennquist S, Dobson R: The prehospital response. In Lennquist S (ed.): Medical Response to Major Incidents and Disasters. Berlin Heidelberg: Springer, 2012. doi:10.1007/978-3-642-21895-8_3.

Alam HB, Burris D, DaCorta JA, et al.: Hemorrhage control in the battlefield: Role of new hemostatic agents. Mil Med. 2005; 170(1): 63-69.

Sauaia A, Moore FA, Moore EE, et al.: Epidemiology of trauma deaths: A reassessment. J Trauma. 1995; 38(2): 185-193.

Heckbert SR, Vedder NB, Hoffman W, et al.: Outcome after hemorrhagic shock in trauma patients. J Trauma. 1998; 45(3): 545-549.

Wade CE, Eastridge BJ, Jones JA, et al.: Use of recombinant factor VIIa in US military casualties for a five-year period. J Trauma. 2010; 69(2): 353-359.

Champion HR, Bellamy RF, Roberts CP, et al.: A profile of combat injury. J Trauma. 2003; 54(5 suppl): S13-S19.

Scope A, Farkash U, Lynn M, et al.: Mortality epidemiology in low-intensity warfare: Israel Defense Forces' experience. Injury. 2001; 32(1): 1-3.

Zajtchuk R, Sullivan GR: Battlefield trauma care: Focus on advanced technology. Mil Med. 1995; 160(1): 1-7.

Committee on Tactical Combat Casualty Care: Tactical Combat and Casualty Care Guidelines. 2014. Available at http://www.usaisr.amedd.army.mil/assets/pdfs/TCCC_Guidelines_140602.pdf. Accessed January 22, 2015.

Owens BD, Kragh JF Jr, Wenke JC, et al.: Combat wounds in operation Iraqi Freedom and operation Enduring Freedom. J Trauma. 2008; 64(2): 295-299.

Clay JG, Grayson JK, Zierold D: Comparative testing of new hemostatic agents in a swine model of extremity arterial and venous hemorrhage. Mil Med. 2010; 175(4): 280-284.

Gerlach T, Grayson JK, Pichakron KO, et al.: Preliminary study of the effects of smectite granules (WoundStat) on vascular repair and wound healing in a swine survival model. J Trauma. 2010; 69(5): 1203-1209.

Alam HB, Chen Z, Jaskille A, et al.: Application of a zeolite hemostatic agent achieves 100% survival in a lethal model of complex groin injury in Swine. J Trauma. 2004; 56(5): 974-983.

Alam HB, Koustova E, Rhee P: Combat casualty care research: From bench to the battlefield. World J Surg. 2005; 29(suppl 1): S7-S11.

Burgert J, Gegel B, Neal AR, et al.: The effects of arterial blood pressure on rebleeding when BleedArrest, Celox and TraumaDex are used in a porcine model of lethal femoral injury. Mil Med. 2012; 177(3): 340-344.

Burgert JM, Gegel BT, Austin R III, et al.: Effects of arterial blood pressure on rebleeding using Celox and TraumaDEX in a porcine model of lethal femoral injury. AANA J. 2010; 78(3): 230-236.

Gegel B, Burgert J, Cooley B, et al.: The effects of BleedArrest, Celox, and TraumaDex on hemorrhage control in a porcine model. J Surg Res. 2010; 164(1): e125-e129.

Gegel B, Burgert J, Gasko J, et al.: The effects of QuikClot Combat Gauze and movement on hemorrhage control in a porcine model. Mil Med. 2012; 177(12): 1543-1547.

Johnson D, Agee S, Reed A, et al.: The effects of QuikClot Combat Gauze on hemorrhage control in the presence of hemodilution. US Army Med Dep J. 2012: 36-39.

Kheirabadi BS, Mace JE, Terrazas IB, et al.: Safety evaluation of new hemostatic agents, smectite granules, and kaolin-coated gauze in a vascular injury wound model in swine. J Trauma. 2010; 68(2): 269-278.

Kheirabadi BS, Mace JE, Terrazas IB, et al.: Clot-inducing minerals versus plasma protein dressing for topical treatment of external bleeding in the presence of coagulopathy. J Trauma. 2010; 69(5): 1062-1072; discussion 1072-1063.

Sondeen JL, Coppes VG, Holcomb JB: Blood pressure at which rebleeding occurs after resuscitation in swine with aortic injury. J Trauma. 2003; 54(5 suppl): S110-S117.

Sondeen JL, Pusateri AE, Coppes VG, et al.: Comparison of 10 different hemostatic dressings in an aortic injury. J Trauma. 2003; 54(2): 280-285.

Z-Medica. QuikClot Combat Gauze. 2013. Accessed November 30, 2013.

Arnaud F, Parreno-Sadalan D, Tomori T, et al.: Comparison of 10 hemostatic dressings in a groin transection model in swine. J Trauma. 2009; 67(4): 848-855.

Arnaud F, Teranishi K, Okada T, et al.: Comparison of Combat Gauze and TraumaStat in two severe groin injury models. J Surg Res. 2011; 169(1): 92-98.

Johnson D, Gegel B, Burgert J, et al.: The effects of QuikClot Combat Gauze, fluid resuscitation and movement on hemorrhage control in a porcine model. ISRN Emerg Med. 2012; 2012: 1-6.

Gegel BT, Austin PN, Johnson AD: An evidence-based review of the use of a Combat Gauze (QuikClot) for hemorrhage control. AANA J. 2013; 81(6): 453-458.

Ran Y, Hadad E, Daher S, et al.: QuikClot Combat Gauze use for hemorrhage control in military trauma: January 2009 Israel Defense Force experience in the Gaza Strip—A preliminary report of 14 cases. Prehosp Disaster Med. 2010; 25(6): 584-588.

Bickell WH, Bruttig SP, Millnamow GA, et al.: The detrimental effects of intravenous crystalloid after aortotomy in swine. Surgery. 1991; 110(3): 529-536.

Pepe PE, Mosesso VN Jr, Falk JL: Prehospital fluid resuscitation of the patient with major trauma. Prehosp Emerg Care. 2002; 6(1): 81-91.

Holmes JF, Sakles JC, Lewis G, et al.: Effects of delaying fluid resuscitation on an injury to the systemic arterial vasculature. Acad Emerg Med. 2002; 9(4): 267-274.

Kowalenko T, Stern S, Dronen S, et al.: Improved outcome with hypotensive resuscitation of uncontrolled hemorrhagic shock in a swine model. J Trauma. 1992; 33(3): 349-353; discussion 361-342.

Santibanez-Gallerani AS, Barber AE, Williams SJ, et al.: Improved survival with early fluid resuscitation following hemorrhagic shock. World J Surg. 2001; 25(5): 592-597.

Henry S, Scalea TM: Resuscitation in the new millennium. Surg Clin N Am. 1999; 79(6): 1259-1267, viii.

Revell M, Porter K, Greaves I: Fluid resuscitation in prehospital trauma care: A consensus view. Emerg Med J. 2002; 19(6): 494-498.

Shires GT, Carrico CJ, Coln D: The role of the extracellular fluid in shock. Int Anesthesiol Clin. 1964; 2: 435-454.

Alam HB, Rhee P: New developments in fluid resuscitation. Surg Clin N Am. 2007; 87(1): 55-72, vi.

Paquette S, Gordon C, Bradtmiller B: Anthropometric Survey (ANSUR) II Pilot Study: Methods and Summary Statistics. Natick, MA: US Army Natick Soldier Research, Development and Engineering Center, 2009: 74-75.

Goldberg ME, Larijani GE, Azad SS, et al.: Comparison of tracheal intubating conditions and neuromuscular blocking profiles after intubating doses of mivacurium chloride or succinylcholine in surgical outpatients. Anesth Analg. 1989; 69(1): 93-99.

Hugh HD: Manual of Operations. Lackland AFB, TX, 2007.




DOI: http://dx.doi.org/10.5055/ajdm.2014.0182

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