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Advanced Hemostatic Dressings Are Not Superior to Gauze for Care Under Fire Scenarios

Watters, Jennifer M. MD; Van, Philbert Y. MD; Hamilton, Gregory J. BS; Sambasivan, Chitra MD; Differding, Jerome A. MPH; Schreiber, Martin A. MD

Journal of Trauma and Acute Care Surgery: June 2011 - Volume 70 - Issue 6 - p 1413-1419
doi: 10.1097/TA.0b013e318216b796
Original Article

Background: Advanced hemostatic dressings perform superior to standard gauze (SG) in animal hemorrhage models but require 2 minutes to 5 minutes application time, which is not feasible on the battlefield.

Methods: Twenty-four swine received a femoral artery injury, 30 seconds uncontrolled hemorrhage and randomization to packing with SG, Combat Gauze (CG), or Celox Gauze (XG) without external pressure. Animals were resuscitated to baseline mean arterial pressures with lactated Ringers and monitored for 120 minutes. Physiologic and coagulation parameters were collected throughout. Dressing failure was defined as overt bleeding outside the wound cavity. Tissues were collected for histologic and ultrastructural studies.

Results: All animals survived to study end. There were no differences in baseline physiologic or coagulation parameters or in dressing success rate (SG: 8/8, CG: 4/8, XG: 6/8) or blood loss between groups (SG: 260 mL, CG: 374 mL, XG: 204 mL; p > 0.3). SG (40 seconds ± 0.9 seconds) packed significantly faster than either the CG (52 ± 2.0) or XG (59 ± 1.9). At 120 minutes, all groups had a significantly shorter time to clot formation compared with baseline (p < 0.01). At 30 minutes, the XG animals had shorter time to clot compared with SG and CG animals (p < 0.05). All histology sections had mild intimal and medial edema. No inflammation, necrosis, or deposition of dressing particles in vessel walls was observed. No histologic or ultrastructural differences were found between the study dressings.

Conclusions: Advanced hemostatic dressings do not perform better than conventional gauze in an injury and application model similar to a care under fire scenario.

From the Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health & Science University, Portland, Oregon.

Submitted for publication October 5, 2010.

Accepted for publication February 21, 2011.

Supported, in part, by The American Association for the Surgery of Trauma/Ethicon Research Scholarship Award and in part by an institutional grant from SAM Medical Products.

No member of the study team has any financial or vested interest in SAM Medical Products and there are no conflicts of interest.

Presented at the 69th Annual Meeting of the American Association for the Surgery of Trauma, September 22–25, 2010, Boston, Massachusetts.

Address for reprints: Jennifer M. Watters, MD, Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code L-611, Portland, OR 97239-3098; email:

© 2011 Lippincott Williams & Wilkins, Inc.