Effectiveness of kaolin-impregnated hemostatic gauze use in preperitoneal pelvic packing for patients with pelvic fractures and hemodynamic instability: A propensity score matching analysis

Abstract

Introduction We evaluated the effectiveness of kaolin-impregnated hemostatic gauze use in preperitoneal pelvic packing (PPP) for patients with hemodynamic instability due to severe pelvic fractures. Materials and methods Between May 2014 and October 2018, 53 of 75 patients who underwent PPP due to hemodynamic instability induced by pelvic fracture were enrolled. Their medical records were prospectively collected and retrospectively analyzed. QuikClot combat gauze (hydrophilic gauze impregnated with kaolin) and general surgical tape were used in 21 patients, while general surgical tape was used in the remaining 32 patients. Results As there were differences in the characteristics of patients between the hemostatic gauze (HG) group and control group, propensity score matching (PSM) was performed to adjust for age, sex, and lactate levels. After PSM, the clinical characteristics between the two groups became similar. There were no differences in the rates of mortality and hemorrhageinduced mortality between the two groups. However, the packed red blood cell (RBC) requirement for an additional 12 hours in the HG group was significantly lower than that in the control group (4.1 ± 3.5 vs. 7.6 ± 6.1 units, p = 0.035). The lengths of intensive care unit and hospital stays tended to be shorter in the HG group than in the control group (11.6 vs. 18.5 days, p = 0.1582; 30.8 vs. 47.4 days, p = 0.1861, respectively).

Design and Preclinical Evaluation of Chitosan/Kaolin Nanocomposites with Enhanced Hemostatic Efficiency

“…Another example of hemostatic agents used is kaolin. The use of heated kaolin slurry in coating non-woven gauze is the most commonly utilized method to prepare hemostatic dressings [ 16 , 17 , 18 ]. However, this method results in low coating efficiency as can be seen in the figure ( Figure 1 A3), which explains the relatively low hemostatic efficiency of this kind of preparations (vide infra).…”

“…Kaolin is an inert naturally occurring hydrated aluminum silicate mineral derived from clay that is widely used as a hemostatic agent. When exposed to plasma, kaolin activates clotting factor XII, a protein factor which assists in the initiation of the coagulation cascade [ 16 , 24 ]. It was reported in one study that addition of kaolin coating materials to blood of patients on anticoagulant therapy significantly reduced the time to clot formation (in vitro testing) [ 25 ].…”

“…However, efficient coating of kaolin onto the carrier is challenging. The use of heated kaolin slurry in coating the non-woven gauze is the most commonly utilized method for preparation of hemostatic dressings [ 16 , 17 , 18 ]. However, this method results in low coating efficiency, which explains the relatively low hemostatic competence of this kind of preparations [ 26 ].…”

Place of preperitoneal pelvic packing in severe pelvic traumatisms: About 20 cases performed in a French military level one trauma center

“…Likewise, the impact of PPP on SBP was evident, as shown in other series where a statistical difference was found between pre-and postoperative SBP ; they all demonstrated a statistically significant increase of SBP (12)(13)(14), as we did (p<0.001). A recent study (17) suggests that kaolin-impregnated hemostatic gauze in PPP could reduce the need for additional packed RBC transfusions in patients with hemodynamic instability due to severe pelvic fractures. This could be a useful improvement to add to reduce the transfusions.…”

In-vitro Analysis of Hemostatic Cotton Khadi Dressing with Kaolin/Chitosan-based Composition and Its Application as Prospective Wound Dressing

“…In various models of puncture and incision, the khadi hemostatic dressing performed relatively faster and more effectively in blood coagulation. Kaolin rapidly promotes blood coagulation by activating the factor XII protein which initiates the coagulation cascade 30,31 . In a previous study, it has been analyzed that the kaolin/chitosan composites showed significantly reduced clotting time and enhanced hemostatic efficiency 28 calculated in two rats after puncturing their leg vein and reapplying hemostatic dressing every 10 seconds until the time when the bleeding stopped.…”