The Effects of QuikClot Combat Gauze, Fluid Resuscitation, and Movement on Hemorrhage Control in a Porcine Model

Abstract

The purpose of this study was to compare the effectiveness of QuikClot Combat Gauze (QCG) compared to a control group on hemorrhage control; the amount of crystalloid volume infusion on rebleeding; the effect of movement on hemorrhage. This was a prospective, experimental design. Swine were randomly assigned to either the QCG () or the control group (). Investigators transected the femoral artery and vein in each swine. After one minute of uncontrolled hemorrhage, the hemostatic agent, QCG, was placed into the wound followed by standard wound packing. The control group underwent the same procedures but without a hemostatic agent. After five minutes of direct pressure, a standard pressure dressing was applied. After 30 minutes, dressings were removed, and the wound was observed for rebleeding for 5 minutes. If hemostasis occurred, 5 liters of crystalloid was given over 5 minutes, and the wound was observed for rebleeding for 5 additional minutes. If no bleeding occurred, the extremity on the side of the injury was moved. There were significant differences in the amount of hemorrhage (), the amount of fluid administration (), and the number of movements () between the QCG and control.

The effect of tantalum incorporation on the physical and chemical properties of ternary silicon–calcium–phosphorous mesoporous bioactive glasses

“…18 However, zeolite-based hemostats can cause an exothermic reaction at the wound site with tissue temperatures capable of rising to 90 C. 13 Combat Gauze (Z-Medica LLC, Wallingford, CT) is a cotton gauze implanted with kaolin that initiates the intrinsic pathway of the blood coagulation cascade. 19 The initiation requires blood to reach kaolin through the gauze and so it is slower in achieving hemostasis compared to other inorganic counterparts. 13 These hemostats have all been shown to reduce bleed time, but have major side effects or drawbacks that limit their use to certain situations.…”

Clotting Activity of Polyphosphate‐Functionalized Silica Nanoparticles

“…[4] Agents such as kaolin or chitosan (Scheme 1) are useful as field therapeutics for management of external hemorrhage and are widely utilized by military forces as a first-response treatment. [5],[6] However, these compounds cannot be administered systemically and therefore lack utility for internal injuries with an intrinsic non-compressible hemorrhage.…”

“…[13] However, due to its negative surface charge, silica is also a contact activator. [5a,14] Consequently, the ideal construction of a polyP-bearing silica nanoparticle would shield the silica from exposure to the systemic circulation, with targeting and exposure of the silica carrier surface and polyP at the site of internal hemorrhage. Current materials used for treating external hemorrhage generally contain particles in the micrometer range, which are too large to easily traverse capillaries and unsuitable for use as intravenous therapeutics.…”

“…[15] We consequently developed an approach for the synthesis of 50 – 100 nm diameter particles (Figure 1L, Table 1). [5a,15] …”

“…Negatively charged particles, such as the aluminosilicate kaolin (QuikClot® Combat Gauze ™ ) used for external injuries, activate the contact pathway,. [4,5a] Because it is a poor clot initiator, polyP attachment shields SNPs in the systemic circulation, which is beneficial for use to control haemorrhage intravenously. We measured the impact of both bare SNPs and polyP-SNPs on clot time using thromboelastography (TEG, Figure 2T, SI Figures 4, 5) on pooled normal plasma (PNP).…”