Page 68 - Journal of Special Operations Medicine - Fall 2017

Table 1 Preinjury Characteristics Table 2 Postintervention Data
QuikClot QuikClot
Characteristic Combat Gauze XSTAT p Value Combat Gauze XSTAT
Baseline values Characteristic (n = 10) (n = 9) p Value
Weight (kg) 76.3 ± 5.0 75.6 ± 4.1 .745 Application time (seconds) 87.1 ± 17.4 71.5 ± 17.6 .069
MAP (mmHg) 60.4 ± 9.2 62.5 ± 10.4 .654 Immediate hemostasis, 0 (0) 1 (11) .474
no. (%)
MPAP (mmHg) 18.3 ± 1.6 18.7 ± 2.7 .756 Eventual hemostasis,
CVP (mmHg) 7.4 ± 1.9 7.2 ± 1.6 .862 no. (%) 4 (40) 8 (89) .057
Heart rate (bpm) 60.3 ± 7.2 55.0 ± 7.2 .135 Time to reach hemostasis a
Temperature (°C) 37.3 ± 0.3 37.1 ± 0.7 .710 (minutes) 33.8 ± 4.8 20.3 ± 9.8 .028
Values after induction of coagulopathy Duration of hemostasis 5.4 ± 9.5 25.6 ± 31.3 .029 a
Hextend coagulopathy 2,975 ± 192 2,947 ± 159 .728 (minutes)
(mL) Time to death (minutes) 35.4 ± 16.0 48.9 ± 29.1 .438
Blood removed (mL) 2,817 ± 187 2,852 ± 209 .704 Early blood loss (mL) 847 ± 665 435 ± 398 .058
INR 1.25 ± 0.05 1.28 ± 0.04 .228 Late blood loss (mL) 312 ± 373 434 ± 435 .377
Hemoglobin (g/dL) 9.9 ± 0.6 10.1 ± 0.9 .557 Survival, no. (%) 0 (0) 1 (11) .474
Temperature (°C) 35.2 ± 0.6 35.1 ± 1.0 .841 a p < .05.
Preinjury MAP (mmHg) 68.7 ± 10.1 66.4 ± 6.4 .574
Postinjury/pretreatment values h emostasis, the time to achieve hemostasis was significantly
Pretreatment blood 849 ± 228 720 ± 225 .479 shorter with XSTAT than with CG (p < .05). Similarly, the du-
loss (mL) ration of hemostasis (i.e., the total time animals survived while
MAP at end of injury hemostatic) was also significant when comparing XSTAT with
(mmHg) 38.9 ± 7.6 38.1 ± 6.4 .538 CG (p < .05).
CVP, central venous pressure; INR, international normalized ratio;
MAP, mean arterial pressure; MPAP, mean pulmonary artery pressure. After completion of packing, blood was collected and weighed.
This blood was separated into that collected during the first
means of each group (Table 1). Coagulopathy was observed 10 minutes after packing (“platinum” 10 minutes) and that
by an increase in international normalized ratio from 1.07 ± collected during the rest of the observation period (Table 2).
0.05 to 1.45 ± 0.10 second (p < .001), and overall hemoglobin During the platinum 10 minutes, CG-treated animals bled
levels decreased from 10.0 ± 0.8g/dL to 4.0 ± 0.4g/dL (p < more than XSTAT-treated animals did, with the differences
.001). Mild hypothermia was observed as rectal temperature approaching significance (p = .058). However, total blood loss
decreased from 37.2°C (99°F) ± 0.5°C (33°F) at baseline down over the full 2-hour observation period was not significantly
to 35.2°C (95.4°F) ± 0.8°C (33.4°F; p < .001) after induction different between groups.
of coagulopathy.
Discussion
Injury
Before injury, animals had a MAP of 67.6 ± 8.4mmHg with This study was performed to evaluate the efficacy of XSTAT
no significant differences between groups (Table 1). Cavity in comparison with CG in a model of junctional hemorrhage,
volumes were similar between groups, with a volume of 104 a leading cause of potentially survivable deaths on the battle-
± 15mL and 117 ± 33mL for the XSTAT and CG groups, re- field. The hemostatic products were tested in a lethal model of
spectively (p = .324). After complete transection of both the axillary arterial and venous injury in the context of adult-sized
axillary artery and vein, 813mL ± 220mL of blood was lost (70–90kg) swine with dilutional coagulopathy. After treat-
after 30 seconds of free bleeding, leading to a mean MAP of ment, the animals were resuscitated with a 500mL bolus of
38.5mmHg ± 6.9mmHg. The two groups were similar after Hextend followed by up to 10L of lactated Ringer’s solution to
injury with no significant differences between means of each keep the MAP between 60mmHg and 65mmHg and to follow
group (Table 1). the Department of Defense consensus model for evaluating he-
mostatic dressings. 18
Hemostatic Dressing Performance
Hemostatic dressings were applied through the pool of blood The results of this study show that XSTAT was more effective
at the wound site. Pack time, which included time for both than CG in reaching and maintaining hemostasis, and had less
the test dressing and Kerlix backing to absorb blood, was 16 bleeding in the first 10 minutes after application. XSTAT also
seconds shorter with XSTAT than with CG (Table 2). The had a quicker application time, confirming previous studies,
number of XSTAT applicators used varied from two to four but this study included both packing of backing and test dress-
(mean, 2.8 ± 0.8 applicator). One XSTAT applicator, of the 27 ing, masking differences between the two dressings. Despite
used, malfunctioned during application. The exact mechanism these results, there were not any significant differences in sur-
of failure was inconclusive and not determined to be user error vival or time of death.
or manufacturer error.
XSTAT-treated animals had significantly less blood loss than
The achievement of hemostasis was considered the primary CG-treated animals during the first 10 minutes after injury.
outcome. Only one animal (in the XSTAT group) had hemo- This period, the platinum 10 minutes, was chosen a priori as an
stasis immediately after treatment. Nearly all XSTAT-treated end point to illustrate differences between products during the
animals achieved an eventual hemostasis, whereas fewer critical period after trauma. This examination of the blood loss
than half of CG did (Table 2). Of the animals that did reach before any animal death offers a more complete comparison of

66 | JSOM Volume 17, Edition 3/Fall 2017