Hemorrhage Control in the Battlefield: Role of New Hemostatic Agents

Abstract

Uncontrolled hemorrhage is the leading cause of preventable combat-related deaths. The vast majority of these deaths occur in the field before the injured can be transported to a treatment facility. Early control of hemorrhage remains the most effective strategy for treating combat casualties. A number of hemostatic agents have recently been deployed to the warfront that can be used to arrest bleeding before surgical control of the source. The purpose of this article is to summarize the background information regarding these hemostatic agents, indications and rationale for their use, and characteristics of these products that may impact effectiveness.

The Effects of BleedArrest, Celox, and TraumaDex on Hemorrhage Control in a Porcine Model

“…In this study, investigators noted that none of the agents produced an exothermic reaction when applied to the wound, and there were no obvious signs of tissue damage. There were concerns and reports of thermal injury to human tissue with some first generation mineral-based hemostatic agents [37]. Secondary to the mechanisms of action and the sterilization of these products, none of the agents tested carries the risk of infection per the manufacturers.…”

Era of Bloodless Surgery: Spotlights on Hemostasic Materials and Techniques

“…Chitin and chitosan, poly-N-acetyl Glucosamine and its deacetylated form, both have hemostatic properties through the mechanisms of tissue adhesion, vasospasm and attraction of circulating blood cells [44]. Chitin dressing has effectiveness in treating small wounds by vasoconstriction and by recruitment of erythrocytes, thrombocytes and coagulation factors, but in severe wounds, it has shown varying results compared with standard dressing [45].…”

“…Decreased effectiveness for high-pressure bleeding was reported and by enclosing it in a gauze pouch, zeolite agent can be administrated under relatively high-pressure without being washed away by the blood stream. Although zeolite is inexpensive, has antimicrobial properties and requires no special storage, it has some complications of thermal injury, scar formation and foreign body reaction [44,48].…”

“…However, the effectiveness of chitosan dressing depends on how well the bandage is attached to the affected area, thus proper application is needed especially on wounds that are not flat. Chitin and chitosan dressings have advantages including lack of protein contamination and toxicity, easy storage and application, and disadvantages including high cost and variability of efficacy [44].…”

Antibacterial hemostatic dressings with nanoporous bioglass containing silver

“…For example, more than 50% of all battlefield casualties result from uncontrolled hemorrhaging. 3 Inorganic oxides with high surface area are attractive for use in medical devices, because these materials are contact activators of the intrinsic pathway of the blood coagulation cascade for inherently polar surfaces. 4,5 The zeolite-based blood-clotting agent called QuikClot ® (Z-Medica Corporation, Wallingford, CT), used for traumatic wound treatments with porous and high-surface-area characteristics, stops high-volume blood loss from large wounds and decreases battlefield mortality.…”