Page 65 - JSOM Winter 2021

Use of Topical Hemostatic Dressings

in an Extended Field Care Model

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Matthew Welch *; Jon Barratt ;
1
Alethea Peters, BM BCh (Oxon.) ; Chris Wright 4
3

ABSTRACT
Background: We sought to test whether Celox topical hemo- a review showing that the hemostatics with the greatest evi-
static dressing (Medtrade Products) would maintain hemo stasis dence of efficacy were Celox gauze, QuikClot Combat Gauze
in extended use. Methods: An anesthetized swine underwent (Z-Medica), and HemCon (Hemcon Medical Technologies,
bilateral arteriotomies and treatment with topical hemostatic Medline Industries). Given that Celox is the topical hemostatic
dressings in line with the Kheirabadi method. The dressings currently used by the British military, it was chosen to be used
were covered with standard field dressings, and these were vi- in this study.
sually inspected for bleeding every 2 hours until 8 hours, when
the swine was euthanized. Results: There was no evidence With the drawdown of operations in Iraq and Afghanistan,
of rebleeding at any point up to and including 8 hours. The the US and UK militaries are focusing on contingency oper-
Celox dressings maintained hemostasis in extended use. Con- ations in a number of locations in the world, including the
clusion: Celox topical hemostatic dressing is effective for ex- Horn of Africa and the Pacific. Operations in these locations
tended use and maintains hemostasis. It should be considered are often remote, and any casualties may endure long delays
for use in situations in which evacuation and definitive care before evacuation or definitive care. Therefore, any topical he-
may be delayed. mostatic being used to arrest a junctional hemorrhage would
be required to provide wound stability for hours to days.
Keywords: hemostatic; trauma; prehospital; hemorrhage; military
The aim of this study was to test whether the Celox topical he-
mostatic dressing would maintain hemostasis for a prolonged
period, simulating a prolonged field care scenario, without re-
bleeding or other adverse outcome.
KEY MESSAGES
• Celox maintains hemostasis and prevents rebleeding
for at least 8 hours. Methods
• In extended use, Celox had no adverse effects, either A single swine was anesthetized and bilateral femoral arteri-
at the wound site or systemically. otomies were performed in line with the Kheirabadi model
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• Celox and other topical hemostatics should be con- for testing topical hemostatics. Standard-roll Celox gauze was
sidered for use when evacuation and/or definitive used to pack the injuries, and the application was carried out
care may be delayed. by a trained Army emergency medicine physician. Because of
• In extended field care scenarios with hemorrhage, in- logistical constraints, the swine had a simulated thoracic in-
cluding amputation, use of topical hemostatics as an jury treated surgically prior to the bilateral femoral arterioto-
adjunct could help to increase survival. mies; this included injury to thoracic vasculature and resulted
in minimal blood loss.

Initial hemostasis was achieved and the topical hemostatics
Introduction
wrapped in standard gauze dressings to secure them in place,
Major hemorrhage is the leading cause of death on the bat- and fluid resuscitation with Ringer’s lactate solution was
1-4
tlefield and in prehospital trauma in certain demographics. started. This is in keeping with both the experimental model
Junctional wounds, such as those to the groin, axilla, shoulder, and guidelines for clinical use. The swine was kept alive for
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and neck, can be especially difficult to deal with because direct 8 hours using standard anesthetic sedation and fluid mainte-
pressure and tourniquets may not arrest hemorrhage in these nance and then euthanized. No vasopressors or blood pressure
areas. Topical hemostatic dressings are thus a lifesaving ad- maintenance agents were used.
junct in these instances and have been used successfully by mil-
itary forces and hospital organisations for more than a decade. The dressings were checked every 2 hours for evidence of
Numerous studies have shown the efficacy of various topical rebleeding or leakage, and monitoring of the swine’s vital
hemostatic dressings, 5-12 and the authors recently conducted signs was carried out throughout the experiment. Following
*Correspondence to Matthew.welch1@nhs.net
2
1 Capt Matthew Welch is affiliated with the University of Oxford, UK. Lt Col Jon Barratt is affiliated with the Emergency Department, Royal
Stoke University Hospital, UK. Dr Alethea Peters is affiliated with the University of Oxford. Col Chris Wright is affiliated with the Emergency
4
3
Department, St. Mary’s Hospital Foundation Trust, London, UK.
The study has appeared in poster form at conferences in Oxford Medical School and for the British military.
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