Page 157 - JSOM Summer 2020

Due to the chemical nature, the bioadhesive readily swells in Using a technology that does not depend on understanding
water, providing a large adhesive surface for maximum contact the underlying physiology of the condition while still work-
with the mucin (the glycoprotein predominant in the mucous ing effectively has the potential to save lives. Complications,
layer), resulting in adhesion of the bioadhesive to the mucin prolonged treatment time, and potential rebleeds can be suc-
while maintaining an adhesive force between the tissue surface cessfully prevented by the timely application of the proprietary
and the product. This key element allows for compression to chitosan-based technology within Celox Rapid. This in turn
be released after 60 seconds compared with the standard pro- has the potential to aid in prognosis, resulting in increased
tocol of care of 3 minutes. probability of survival.

A second aspect is the hydrogen bonding network within the Disclosure
chitosan matrix, which can extend to the amino acids present All authors are employees of work for Medtrade Products
in the tissues, giving a degree of adhesion to the wound. This Limited; Celox is a trademark of Medtrade Products Limited,
adhesion could also be caused by an electrostatic interaction all rights reserved.
between the positively charged chitosan salt and the lone pair
of tissue amine groups. Laboratory studies have shown that References
the tissue adhesion properties of Celox Rapid are significantly 1. Morrison CA. The prehospital treatment of the bleeding pa-
higher than other products on the market irrespective of the tient—dare to dream. J Surg Res. 2013;180(2):246–247.
11
profile of the blood (i.e., whole blood or compromised blood 2. World Health Organization. Cause-Specific Mortality and Mor-
bidity. 2009.
[diluted or anticoagulated]). 3. Cothren CC, et al. Epidemiology of urban trauma deaths: a com-
prehensive reassessment 10 years later. World J Surg. 2007;31(7):
Following absorption of fluids and after the creation of the 1507–1511.
robust gel, a further element of this adhesive characteristic can 4. Sharrock AE, et al. Combat vascular injury: influence of mech-
be observed between the gauze layers. This adhesive charac- anism of injury on outcome. Injury. 2018. doi:10.1016/j.injury
teristic helps stabilize the different layers of the gauze during .2018.06.037
packing and combined with the tissue adhesion and helps hold 5. Brohi K, et al. Acute traumatic coagulopathy. J Trauma. 2003;54
(6):1127–1130.
and maintain the gel-like clot even during movement of the 6. Davenport R, et al. Functional definition and characterization
patient, reducing the risk of rebleeding during evacuation. of acute traumatic coagulopathy. Crit Care Med. 2011;39(12):
2652–2658.
The multiple hydrogen bonding interactions throughout the 7. Hayakawa M. Pathophysiology of trauma-induced coagulopa-
gel structure, extending to the tissues, give sufficient cohesive- thy: disseminated intravascular coagulation with the fibrinolytic
ness to the structure of the device to effectively plug the wound phenotype. J Intensive Care. 2017;5:14.
and stop bleeding irrespective of the profile of the blood. 8. Kushimoto S, Kudo D, Kawazoe Y. Acute traumatic coagulopa-
thy and trauma-induced coagulopathy: an overview. J Intensive
Care. 2017;5:6.
On formation of the robust gel plug around the site of bleed- 9. Hattori H, Ishihara M. Changes in blood aggregation with dif-
ing, the combination of the different properties of the product ferences in molecular weight and degree of deacetylation of chi-
and the gel plug create a conducive environment to allow the tosan. Biomed Mater. 2015;10:1–7.
body to naturally undertake the hemostasis process, while min- 10. Data on file, Medtrade. In-vitro test data assessing absorption of
imizing the risk of rebleed due to movement or other forces. 12 diluted and anti-coagulated blood and gel formation under dif-
ferent conditions. For more information please contact us via our
website www.celoxmedical.com or via email at celoxenquiries@
In in vivo models using the Institute of Surgical Research fem- medtrade.co.uk
oral artery 6mm punch model, the proprietary chitosan-based 11. Data on file, Medtrade. In-vitro test data assessing tissue adhe-
hemostatic technology in Celox Rapid was shown to work in sion. For more information please contact us via our website
both normal and compromised blood conditions. 12,13 These www.celoxmedical.com or via email at celoxenquiries@medtrade
.co.uk
data support the findings of the in vitro testing and the rel- 12. Data on file, Medtrade, In-vivo test data assessing hemostasis and
evance of the tests. The blood within these tests was diluted rebleed during movement. For more information please contact
with Hextend (by 33%) and made hypothermic (35° C). us via our website www.celoxmedical.com or via email at celox-
enquiries@medtrade.co.uk
In a trauma environment, whereby diagnosis of any underly- 13. Data on file, Medtrade, In-vivo test data assessing hemostasis in
ing complicating condition is neither practical nor currently normal and compromised blood conditions. For more informa-
available, speed and effectiveness of treatment are essential. tion please contact us via our website www.celoxmedical.com or
via email at celoxenquiries@medtrade.co.uk

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