Page 69 - Journal of Special Operations Medicine - Spring 2015

(Covidien, Mansfield, MA), was placed until the wound Results
cavity was filled. The same procedures were used for the There were no statistically significant differences be­
control group with the deletion of the QCG.
tween the groups in reference to the amount of initial
1­minute hemorrhage, body weight, core body tem­
In both groups, firm manual pressure of 25lb/in , as mea­ peratures, arterial blood pressure, pulse, mean arterial
2
sured with an electronic TIF scale (Thermal Industries pressure, blood volume, amount of fluid resuscitation,
of Florida/Robinair, Owatonna, MN, USA; http://www. or the amount of initial hemorrhage (p = .292). The
robinair.com/), was applied for 5 minutes to the injury mean volume of fluid replacement was 4454.86mL
site. The TIF scale is precise to within 0.5 oz and accu­ (mean ± SD was 4338.18 ± 673.48mL in the QCG
rate to within 0.5%. The scale was placed between the group and 4571.55 ± 750.32mL in the control group).
31
combat litter and the operating room table and zeroed The mean temperature was 33.31°C (mean ±SD was
in accordance with manufacturer’s instructions. There­ 33.05°C ± 0.64°C in the QCG group and 33.57°C ±
after, 500mL of Hextend (Hospira, Inc, Lake Forest, IL, 0.34°C in the control group). The ACT was within
USA; http://www.hospira.com) was administered to all normal limits for all subjects. An independent t test
the subjects in accordance with current battlefield resus­ was used to determine if there was a statistically sig­
citation protocol recommended by the CoTCCC. Hex­ nificant difference in the number of movements before
tend is a formulation of 6% hetastarch combined with hemorrhage occurred. The QCG group was able to
a physiologically balanced crystalloid carrier that more tolerate movements more than the control group (p <
closely mirrors plasma electrolyte balance than 6% het­ .0001) (Table 1).
astarch in 0.9% sodium chloride. After 5 minutes of di­
rect pressure, a 10­lb sandbag was applied to the wound Table 1 Summary of Extremity Movements Before Rebleeding
for additional 30 minutes. After 35 minutes of pressure
(5 minutes of manual pressure plus 30 minutes with the Group Movements, No. p value
sandbag), the standard pressure dressing was removed. It QCG 32.92 ± 14.062 <.0001
was not possible to blind the investigator relative to the Control 6.15 ± 15.021 <.0001
use of QCQ or a standard dressing. However, the subse­
quent researchers were blinded to group assignment rela­
tive to observation of hemorrhage after the 30 minutes. Discussion
In addition, the individual conducting the movement of
the extremities was blinded. QCG is used by the US Military and in many civil­
ian sectors for management of massive hemorrhage in
For the purposes of this study, hemostasis was defined as trauma casualties. The US Military’s CoTCCC is re­
a clot formation with oozing of 2% or less of the swine’s sponsible for developing guidelines for the management
total blood volume over a 5­minute period (100mL in a of wounded military personnel. It recommends QCG as
70kg pig). The investigators consulted with three experts the first­line hemostatic agent for use in treatment of
(trauma surgeons) relative to what they believed to be severe hemorrhage. The findings of this study support
clinically important relative to the definition. After dis­ the recommendations.
cussion, they were unanimous that hemostasis should be
defined as 2% or less of the swine’s total blood volume One goal of the US Army is that each soldier carries a
over a 5­minute period. For the swine with hemostasis, hemostatic agent. QCG produces a robust clot that can
the clot was further challenged with 5 L IV crystalloid withstand significant movement. The movements were
solution rapidly administered through the central venous completed to a maximum range of motion, but this
catheter over 5 minutes. If rebleeding occurred during should be avoided in patients with an inguinal injury. In
crystalloid infusion, the experiment was terminated. this study, however, the investigators wanted reproduc­
ible movements that would test the robustness of newly
For the subjects that achieved hemostasis, the investi­ formed clot.
gators systematically moved the leg on the side of the
injury. On a real battlefield, personnel would take sig­ Funding
nificant precautions when moving combat casualties.
For this study movement consisted of the following: This study was supported by a grant from the TriService
flexion, extension, abduction, and adduction 10 times Nursing Research Program.
sequentially or until rebleeding occurred. The move­
ments consisted of a full range of motion. The number Disclosures
of movements were counted up to 40 (10 of each move­
ment) or until there was bleeding (2% of blood volume). The authors declare no conflicts of interest.

Effect of Movement on Hemorrhage Using QuikClot Combat Gauze 59
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