Originally Posted by
DevL
The chitogauze performed better by 8% but somehow QuikClot is better? Because 8% more deaths? Because science? Did I do the math wrong? I know Celox Rapid works twice as fast as Combat gauze from QuikClot.
Fair question. I only pasted the section with the conclusion. Too lazy to format (I'm just pasting from Word so it's going to be hard to read) but here's the rest of my notes from that portion of the class. Basically, there were questions about methodology/validity of the studies for the chitogauze results which is what the '???' was meant to indicate.
o USAISR Model
* Us Army Model
* 6mm laceration in femoral artery
* Free bleeding and agent applied into blood pool
* No more than two applications of agent
* Did the bleeding stop, re bleeding, alive at 180 minutes
* 100% fatal with ‘standard’ gauze treatment
o Combat Gauze
* Kaolin coated 50% rayon, 50% polyester non woven gauze
* The Co TCCC hemostatic agent of choice at this time
* Evidence
* USA ISR Protocol (6mm Fem Artery Punch)
o 20 of 25 applications – pigs survived three hours
o 0 of 25 applications resulted in initial hemostasis
o $40 a roll – 2014 government pricing
* NOT super impressive
* The Israeli Experience in the Gaza Strip
* Only used by paramedics and physicians
* 13 casualties treated with Combat Gauze
* 79% effective in controlling bleeding
* In 3 ineffective cases the site of bleeding wasn’t accessible to the gauze
* Do we KNOW these guys were going to die otherwise? No, not really.
o HemCon Bandage
* Fairly rigid Chitosan dressing forms a mucoadherent physical barrier at the site of injury
* Truly the first hemostatic agent developed
* Standard US Army hemostatic agent from 2003 to 2008
* Multiple animal studies, two clinical human studies suggested efficacy
* Evidence
* USA ISR Protocol (6mm Fem Arty Punch)
o 2 of 41 successful applications – pigs survived three hours
o 6 of 47 applications results in 2 hour survival with 6mm femoral artery laceration
o Abandoned by DoD in 2008
o 4 x 4 cm bandage costs $149
o IT DOESN”T WORK
o QuikClot
* Zeolite is a hard granule that quickly absorbs water from blood to concentrate elements of coagulation at the site of bleeding
* The secondary US Army hemostatic agent from 2003 to 2008, for use if Hemcon failed or wasn’t available
* Unable to control hemostasis in USAISR model - all pigs die repeatedly
* USAISR – No further testing, it doesn’t’ work
o Celox
* USA ISR Protocol (6 mm fem arty punch)
* 6 of 16 applications – pigs survived three hours
* 7 of 16 applications resulted in initial hemostatis
* 19 of 26 additional pigs surived a 6mm arty punch two hours (10/20 celox trauma gauze)
* $23.59 for 35 gram packet, Celox Rapid $40.00 a roll
* Celox Gauge can be used if Combat Gauze is not available
o WoundStat
* Granular blend of smectite mineral and a super absorbent polymer
* Briefly adopted in 2008 but abandoned because of stroke risk
o ChitoGauze
* Chitosan coated rayon polyester blend of non-woven gauge
* USA ISR Protocol
* Worked “as well as Combat Gauze” in 7 pigs
* Two studies to date – 14/20 pigs survived 150 minutes
* $49.52 a roll 4 inch wide, $28.00 if three inch wide
* Some questions about methodology/results
o Hemostatics Summary – 2 or 3 hr survival & 4 or 6mm femoral artery laceration
* Combat Gauze: 46/63 pigs survive
* ChitoGauze: 28/35 pigs survive???
* Celox (all types): 34/52 pigs survive
* HemCon Bandage: 7/51 pigs survive
* QuikClot ACS: Worse than Hemcon
* WoundState: Clots well, destroys arteries
o I’m confused….
* Combat gauze is the TCCC hemostatic dressing of choice. Chitogauze and Celox Gauze may also be used if CG is not available
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