Standard Gauze versus Hemostaic Agents: A New Look

A recent article published by the Academic Emergency Medicine journal found that when compared to standard gauze, hemostatic agents showed no improvement in hemorrhage control and prevention of re-bleeding. The findings indicated that the training is the the most important aspect of hemorrhage control. Obviously, hemostatics have their place, but they are not magic fairy-dust to be sprinkled on wounds, hoping for the best outcome. Moreover, it is clear that the basics saves lives, as the gauze and hemostatics were under direct pressure for five minutes. Finally, the study reveals the difficulties in accessing certain wounds–cavity versus puncture–with gauze and other delivery methods that ought to be considered.

(It should be noted that this study was funded by the US distributor of Celox, Sam Medical, but conducted by an agency within the Department of the Navy.)

Full Study
Littlejohn Hemostatic Comparison AEM 2011

Abstract

Objectives: Uncontrolled hemorrhage remains one of the leading causes of trauma deaths and one of
the most challenging problems facing emergency medical professionals. Several hemostatic agents have
emerged as effective adjuncts in controlling extremity hemorrhage. However, a review of the current literature
indicates that none of these agents have proven superior under all conditions and in all wound
types. This study compared several hemostatic agents in a lethal penetrating groin wound model where
the bleeding site could not be visualized.

Methods: A complex groin injury with a small penetrating wound, followed by transection of the
femoral vessels and 45 seconds of uncontrolled hemorrhage, was created in 80 swine. The animals
were then randomized to five treatment groups (16 animals each). Group 1 was Celox-A (CA),
group 2 was combat gauze (CG), group 3 was Chitoflex (CF), group 4 was WoundStat (WS),
and group 5 was standard gauze (SG) dressing. Each agent was applied with 5 minutes of manual
pressure. Hetastarch (500 mL) was infused over 30 minutes. Hemodynamic parameters were recorded
over 180 minutes. Primary endpoints were attainment of initial hemostasis and incidence of
re-bleeding.

Results: Overall, no difference was found among the agents with respect to initial hemostasis, rebleeding,
and survival. Localizing effects among the granular agents, with and without delivery mechanisms,
revealed that WS performed more poorly in initial hemostasis and survival when compared to
CA.