Page 51 - Journal of Special Operations Medicine - Fall 2014

Table 2 Ideal Characteristics of Standard Gauze, Combat Gauze, ChitoGauze, and Celox Gauze and Celox RAPID
Ideal Characteristics ‡ Standard Gauze Combat Gauze ChitoGauze Celox Gauze Celox RAPID*
Stops arterial bleeding 2–3 min No Yes Yes Yes Unknown †
manual compression
Stops coagulopathic bleeding No Yes/No § Yes Yes Unknown †
Side effects or excessive heat No No No No No
Safe for medics and causes no pain Yes Yes Yes Yes Yes
Ready and easy to use Yes Yes Yes Yes Yes
Little training requirement Yes Yes Yes Yes Yes
Lightweight and durable Yes Yes Yes Yes Yes
Shelf life duration (years) 5 3 3 4 4
Effective at extreme temperatures Yes Yes Yes Yes Yes
FDA-approved Yes Yes Yes Yes Yes
Biodegradable/bioabsorbable No No No No No
Approximate retail costs $4.00 $48.00 $48.00 $41.00 $45.00
Compression time recommended (min) ¶ 5 3 3 3 1
Duration of use** Days 24 hours 48 hours 7 days 7 days
Indications for internal use No No No No No
Safety evidence †† Yes Yes Yes Yes Yes
Notes: *Celox RAPID gauze does not have sufficient published studies reporting superior or equal efficacy to the other dressings cited in this
table to warrant a recommendation for use at this time.
†Insufficient published studies to date; further research is required.
‡Modified list based on Kheirabadi (2011): unpublished data, per footnote 14.
§Inconsistent published results. See Proximate Cause #3; New FDA Indication approved March 2013 for use in patients taking drug/induced
anticoagulation treatment, Plavix, or Coumadin, not for trauma-induced coagulopathy.
¶At least or until bleeding stops.
**Per manufacturer’s specifications for continuous wound application.
††Based on clinical use and no report complications.

biodegradable. Chitosan breaks down in the body into works primarily via electrostatic interaction with
glucosamine and N-acetyl glucosamine components. erythrocytes, the hemostatic agent may also be effec-
53
Extensive safety studies have been conducted on chitosan tive in the presence of coagulopathy. Chitosan-based
over many decades. A recent review article summarizes hemostatics have been shown in laboratory tests to be
the vast amount of safety studies, making it ideal for a effective when treating hepatic injury bleeding in the
range of applications, including wound healing. presence of moderate systemic heparinization in swine
54
22
or in an arterial bleeding model in warfarin-treated rats
55
23
In 1997, Rao and Sharma investigated the hemostatic with hypothermia. Chitosan has also been effective
mechanism of chitosan and found that it appears to in a range of coagulopathic bleeding scenarios includ-
be independent of the classical coagulation cascade. In ing severe coagulopathy post extracorporeal membrane

2010, Millner et al. reinforced these findings by stat- oxygenation (ECHO).
25
22
ing that the hemostatic activity of chitosan appears to
be via direct electrostatic interaction between the nega- If chitosan alters the clotting parameters measured in
tively charged cell membranes of erythrocytes and the thromboelastography (TEG), it would indicate a mecha-
positively charged chitosan. This interaction of chito- nism other than the attraction of erythrocytes. Khei-
14

9
san with red blood cells forms an adherent gel, which rabadi and Kheirabadi et al. carried out in vitro TEG
tamponades the wound. It has also been suggested that studies on blood exposed to chitosan clotting dressings
chitosan works through platelet adhesion and aggrega- (Celox, HemCon Bandage) as well as mineral-based he-
tion. However, in 1992, Klokkevold et al. showed mostatics and stated that Celox and HemCon Bandage
56
19
that chitosan was effective in the presence of a platelet showed no effect on clotting parameters (nonprocoagu-
antagonist (epoprostanol), indicating that the material lant), providing further evidence that the hemostatic func-
does not depend solely on platelet activation or aggre- tion of chitosan agents is mediated mainly via their tissue
gation to be an effective hemostat. Because chitosan adhesiveness. By contrast, the mineral-based hemostatic
Chitosan-Based Hemostatic Gauze Dressings 43