Page 51 - Journal of Special Operations Medicine - Winter 2014

Fast, Portable Capnography

Evaluation of NuStat , a Novel Nonimpregnated
®
™
for Field Medicine Hemostatic Dressing, Compared With Combat Gauze in
Severe Traumatic Porcine Hemorrhage Model

Genevieve R. Hillis, BME, DO; Crystal J. Yi, DO; David L. Amrani, PhD, FAHA, FAIMBE;
Troy W. Akers, DO; Richard Schwartz, MD, FACEP; Ian Wedmore, MD, FACEP, FAWM, DiMM;
John G. McManus, MD, MBA, MCR, FACEP, FAAEM

Please visit Masimo ABSTRACT
at the 2014 Special Background: Uncontrolled hemorrhage remains one of In this porcine model of uncontrolled hemorrhage, NS
the most challenging problems facing emergency medi- improved immediate hemorrhage control, stability, and
Operations Medical
cal professionals and a leading cause of traumatic death use of fluid in a 60-minute severe porcine hemorrhage
Association Scientific in both battlefield and civilian environments. Survival model. In this study, NS demonstrated equivalence to
Assembly (SOMSA) is determined by the ability to rapidly control hemor- CG at achieving long-term hemostasis and the preven-
rhage. Several commercially available topical adjunct tion of rebleed after application. NS was shown to be
Booth #304P
agents have been shown to be effective in controlling an efficacious choice for hemorrhage control in combat
hemorrhage, and one, Combat Gauze (CG), is used and civilian emergency medical service environments.
™
regularly on the battlefield and for civilian applications.
However, recent literature reviews have concluded that Keywords: EMS, hemostatic dressing, uncontrolled hemor-
no ideal topical agent exists for all injuries and sce- rhage, severe hemorrhage, traumatic injuries, NuStat, NS,
narios. The authors compared a novel nonimpregnated CG, silica, bamboo, cellulose, Combat Gauze, kaolin
dressing composed of cellulose and silica, NuStat
®
(NS), to CG in a lethal hemorrhagic groin injury. These
dressings were selected for their commercial availabil- Introduction
ity and design intended for control of massive hemor- Despite advances in combat casualty care and civilian
rhage. Methods: A complex penetrating femoral artery emergency medical service (EMS) response and training,
groin injury was made using a 5.5mm vascular punch almost 50% of current combat fatalities in Iraq and Af-
followed by 45 seconds of uncontrolled hemorrhage in ghanistan before evacuation and up to 80% of civilian
15 swine. The hemostatic dressings were randomized trauma fatalities within the United States are attributed
EMMA™ is a small, fast, self-contained mainstream 1–4
using a random sequence generator and then assigned to uncontrolled hemorrhage. Efficacious and rapid
capnograph that requires no routine calibration and to the animals. Three minutes of manual pressure was hemorrhage control is crucial for decreased morbidity
™
virtually no warm-up time . With rapid measurement applied with each agent after the free bleed. Hextend and mortality. Over the past decade, significant research
1
of end-tidal carbon dioxide (EtCO2) and respiration bolus (500mL) was subsequently rapidly infused using a in both civilian and military sectors has focused on the
standard pressure bag along with the addition of main- development of novel hemorrhage control agents and
rate, EMMA provides continuous monitoring with
tenance fluids to maintain blood pressure. Hemody- approaches to hemorrhage care. The military has re-
endotracheal tube placement. EMMA also helps you namic parameters were recorded every 10 minutes and searched and adopted many newly developed agents, in-
guide ventilation rates and monitor the effectiveness of additionally at critical time points defined in the proto- cluding redesigned tourniquets, hemostatic agents, and
5–7
CPR, allowing you to make adjustments in the course of col. Primary end points included immediate hemostasis wound dressings to address these needs. Given the in-
treatment, breath by breath. upon release of manual pressure (T0), hemostasis at 60 tended use of the dressings in trauma and battlefield ap-
minutes, and rebleeding during the 60-minute observa- plications, these dressings and agents are also applicable
tion period. Results: NS was statistically superior to CG for civilian use and application.
in a 5.5mm traumatic hemorrhage model at T0 for im-
National Stock Number (NSN) 6515-01-626-8691
mediate hemostasis (p = .0475), duration of application QuikClot (ZMedica Corp.; www.z-medica.com/health
®
NATO Number (6630 16 005 7683) time (p = .0093), use of resuscitative fluids (p = .0042) care), HemCon Bandage (HemCon, Inc.; http://www
®
®
Distribution and Pricing Agreement (DAPA)(SP00200-03-H-0008) and additional blood loss after application (p = .0385). .hemcon.com/), ChitoFlex (HemCon, Inc.; http://www
NS and CG were statistically equivalent for hemosta- .hemcon.com/), and Combat Gauze (Z-Medica Corp.;
™
sis at 60 minutes, rebleeding during the study, and the www.z-medica.com/healthcare) have been used by the
additional secondary metrics, although the trend indi- military for battlefield trauma applications. These he-
cated that in a larger sample size, NS could prove sta- mostatic agents were effective in external hemorrhage
800-257-3810 | www.masimo.com
tistical superiority in selected categories. Conclusions: control, but varying limitations were found with human
© 2014 Masimo. All rights reserved. 1 EMMA Users Manual.
Caution: Federal law restricts this device to sale by or on the order of a physician.
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