Assessment of Hemostatic Dressings for Compressible Wounds in a Swine Model Simulating Prolonged Field Care.

Abstract

INTRODUCTION: Most potentially survivable combat deaths occur from hemorrhage. With the future potential for large scale combat operations, surgical treatment of wounded combatants will be delayed, necessitating prolonged prehospital care. We tested whether 6 hemostatic dressings could control junctional hemorrhage for up to 24 hours. MATERIALS AND METHODS: Female Yorkshire swine were randomized into 9 groups: no intervention, non-hemostatic control gauze, Combat Gauze, Celox Gauze, ChitoGauze, Celox Rapid, Veriset, and CounterFlow Gauze.Following anesthesia, the femoral artery received arteriotomy, and a 45 second uncontrolled hemorrhage before treatment was applied. Animals were monitored for up to 24 hour or until euthanasia criteria were met. If the first 3 animals receiving each treatment did not survive 2 hour, the baseline survival threshold was not met and additional animals were not performed. Primary outcomes were survival time and 24 hour survival rate. RESULTS: All animals without intervention died (<30 minutes). Only Combat Gauze, Celox Gauze, Celox Rapid, and Veriset groups met the survival threshold and included 5 animals. Ranking by survival time was Veriset (19.4&#x2009;&#xb1;&#x2009;10.3 hour), Combat Gauze (16.7&#x2009;&#xb1;&#x2009;10.5 hour), Celox Gauze (15.1&#x2009;&#xb1;&#x2009;12.2 hour), and Celox Rapid (14.9&#x2009;&#xb1;&#x2009;12.4 hour). Veriset achieved 80% survival rate although each of the other 3 groups were 60%. Post-treatment estimated blood loss was least in Veriset (1.0% of body weight) and greatest in Celox Gauze (2.0%) groups. CONCLUSIONS: In this pilot study, Combat Gauze, Celox Gauze, Veriset, and Celox Rapid achieved survival beyond 2 hour in a fatal junctional wound. These should be considered for use in casualties with junctional hemorrhage especially under conditions requiring prolonged prehospital care.