Catastrophic haemorrhage in military major trauma patients: a retrospective database analysis of haemostatic agents used on the battlefield

Winstanley, M; Smith, Jessi L.; Wright, Cameron D.

doi:10.1136/jramc-2018-001031

Cited by 21 publications

(15 citation statements)

References 18 publications

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“…Two studies reported a higher incidence of wound infections with tourniquet use 15 16. Four studies investigating the use of hemostatic dressings (HemCon (HemCon Medical Technologies, Portland, Oregon), QuikClot Combat Gauze (Z-Medica, Wallingford, Connecticut) or Celox (SAM Medical, Tualatin, Oregon)) demonstrated effective hemorrhage cessation and overall improved survival compared with non-hemostatic dressings 8 14 20 22…”

Section: Resultsmentioning

confidence: 99%

“…Three RCTs46 61 63 had low risk of bias (tables 2–4, and online supplemental table 3). Forty-three (78%) of non-randomized cohort studies were classified as having poor evidence quality8 10–15 18–33 35 38 40–43 45 49 51 52 54 55 57–59 69 70 and 12 (22%)16 17 36 37 44 47 50 53 56 60 65 66 had good evidence quality as per the NOS. In addition, the diagnostic studies68–70 included in this review had a high overall risk of bias as per QUADAS-2.…”

Section: Resultsmentioning

confidence: 99%

“…Seventeen studies [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] describing interventions for hemorrhage control such as hemostatic wound dressings, 8 14 20-22 tourniquets, 9-13 15 16 18 19 24 and thoracotomy 17 in the prehospital setting (military and civilian) were included (study participant n=35 666). Studies assessing tourniquets reported better hemodynamic control, 10 with an improved shock index on arrival to the receiving facility (p=0.005).…”

Section: Massive Hemorrhage Controlmentioning

confidence: 99%

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Evaluating the Tactical Combat Casualty Care principles in civilian and military settings: systematic review, knowledge gap analysis and recommendations for future research

Strauss

Menchetti

Perrier

et al. 2021

Trauma Surg Acute Care Open

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ObjectivesThe Tactical Combat Casualty Care (TCCC) guidelines detail resuscitation practices in prehospital and austere environments. We sought to review the content and quality of the current TCCC and civilian prehospital literature and characterize knowledge gaps to offer recommendations for future research.MethodsMEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials were searched for studies assessing intervention techniques and devices used in civilian and military prehospital settings that could be applied to TCCC guidelines. Screening and data extraction were performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Quality appraisal was conducted using appropriate tools.ResultsNinety-two percent (n=57) of studies were observational. Most randomized trials had low risk of bias, whereas observational studies had higher risk of bias. Interventions of massive hemorrhage control (n=17) were wound dressings and tourniquets, suggesting effective hemodynamic control. Airway management interventions (n=7) had high success rates with improved outcomes. Interventions of respiratory management (n=12) reported low success with needle decompression. Studies assessing circulation (n=18) had higher quality of evidence and suggested improved outcomes with component hemostatic therapy. Hypothermia prevention interventions (n=2) were generally effective. Other studies identified assessed the use of extended focused assessment with sonography in trauma (n=3) and mixed interventions (n=2).ConclusionsThe evidence was largely non-randomized with heterogeneous populations, interventions, and outcomes, precluding robust conclusions in most subjects addressed in the review. Knowledge gaps identified included the use of blood products and concentrate of clotting factors in the prehospital setting.Level of evidenceSystematic review, level III.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Massive Hemorrhage Controlmentioning

confidence: 99%

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Evaluating the Tactical Combat Casualty Care principles in civilian and military settings: systematic review, knowledge gap analysis and recommendations for future research

Strauss

Menchetti

Perrier

et al. 2021

Trauma Surg Acute Care Open

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“…Hemorrhage is a leading cause for death. [1,2] Uncontrolled bleeding is reported to contribute to 34% of the deaths in accidents and 91% of the battle field death. [2,3] The conventional method for hemorrhage control is to mechanically press a cotton gauze/dressing on a bleeding wound; [4,5] the cotton gauze absorbs water and increases the concentration of clotting factors such as platelets around the wound, expediting the tissue-adhesive interface by a triggering solution.…”

Section: Introductionmentioning

confidence: 99%

Nonwetting Nanostructured Hemostatic Material for Bleeding Control with Minimal Adhesion

Niu

Zhao

et al. 2021

Adv Materials Inter

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clotting speed by promoting coagulation reactions. [6,7] However, the commonly used hydrophilic hemostatic materials have the following drawbacks. [7,8] First, they are not effective in bleeding control. As clotting passively depends on the coagulation process, bleeding through the hydrophilic material will not stop until the formation of a strong clot to seal the wound. Second, after clot solidification, the hydrophilic dressing soaked blood would form a composite that strongly adheres on the wound, making it difficult to remove the dressing for subsequent wound care; forced peeling would cause tear, secondary bleeding and infection. [9,10] To deal with these problems, hemostatic materials based on new strategies for clot formation have been developed. [6,7,[11][12][13][14][15] Inspired by the fibrin meshwork generated during clot formation, modified chitosan with hydrophobic functional groups was developed; the hydrophobic groups can insert to the membrane of red blood cells, forming a cell-spanning network to seal the wound; [13] but the network may be disturbed by running blood, resulting in blood loss. Under a similar framework, thin layers of peptide were coated on normal hemostatic materials; upon contact with blood, peptides could self-assemble and form nanofiber structures, trapping red blood cells and generating a clot independent of body's coagulation mechanism, which would be beneficial for people with coagulation disorders. [14] Adhesive hydrogel with strong adhesion on wet tissue was also developed for hemostatic applications. [16] Biomacromolecule hydrogel mimicking the extracellular matrix could crosslink under UV irradiation to seal the wound; [15] dry tissue adhesive could absorb water and form physical and covalent cross-links with the wet tissue to seal the bleeding wound. [17] However, the peptide material or the adhesive hydrogel would have strong adhesion and prevent gauze removal for subsequent wound treatment.To address these limitations, surface hydrophobicity and detachable hydrogel was leveraged to enhance the hemostatic performance and to reduce wound adhesion. [7,8,18] A hydrophobic coating prepared on the external surface of cotton dressing could function as a permeation barrier to prevent blood seepage and reduce blood loss. [7] Detachable tissue adhesive was also developed for bleeding control; [19] the bioadhesive applied on a bleeding wound could be removed by cleaving the physical and chemical cross-links at the

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“…In such conditions, the severity and number of wounds exacerbate the challenge of controlling bleeding quickly [8]. In a metaanalysis within a combat setting, where minimising treatment time is critical, Celox Gauze outperformed the other haemostatic agents tested, and was the only one to demonstrate a statistically significant improvement in survival, including in the more severely injured [9].…”

mentioning

confidence: 99%

A Real-World, Case-Led Evaluation of the Haemostatic Dressing Range, Celox™ and How it Can Rapidly Stop Severe Haemorrhage to Help Preserve Life in Emergency Trauma Situations

Fourie¹,

Marshall²

2021

Trauma Cases Rev

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Catastrophic haemorrhage in military major trauma patients: a retrospective database analysis of haemostatic agents used on the battlefield

Cited by 21 publications

References 18 publications

Evaluating the Tactical Combat Casualty Care principles in civilian and military settings: systematic review, knowledge gap analysis and recommendations for future research

Evaluating the Tactical Combat Casualty Care principles in civilian and military settings: systematic review, knowledge gap analysis and recommendations for future research

Nonwetting Nanostructured Hemostatic Material for Bleeding Control with Minimal Adhesion

A Real-World, Case-Led Evaluation of the Haemostatic Dressing Range, Celox™ and How it Can Rapidly Stop Severe Haemorrhage to Help Preserve Life in Emergency Trauma Situations

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