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QuikClot Use in Trauma for Hemorrhage Control: Case Series of 103 Documented Uses

Rhee, Peter MD, MPH; Brown, Carlos MD; Martin, Matthew MD; Salim, Ali MD; Plurad, Dave MD; Green, Donald MD; Chambers, Lowell MD; Demetriades, Demetrios MD, PhD; Velmahos, George MD; Alam, Hassan MD

The Journal of Trauma: Injury, Infection, and Critical Care: April 2008 - Volume 64 - Issue 4 - p 1093-1099
doi: 10.1097/TA.0b013e31812f6dbc
Original Articles
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Background: Local hemostatics have recently been introduced for field use to control external hemorrhage. The objective of this report is to describe the initial clinical experience with QuikClot, a zeolite that works by absorbing water and concentrating coagulation factors to stop bleeding in a series of patients.

Methods: Documented cases using a self-reporting survey sheet submitted by the users and first-hand detailed interviews with the users when possible.

Results: There were 103 documented cases of QuikClot use: 69 by the US military in Iraq, 20 by civilian trauma surgeons and 14 by civilian first responders. There were 83 cases involving application to external wounds and 20 cases of intracorporeal use by military and civilian surgeons. All field applications by first responders were successful in controlling hemorrhage. The overall efficacy rate was 92% with eight cases of ineffectiveness noted by physicians in morbid patients with massive injuries when the QuikClot was used as a last resort. These reported failures were thought to be a result of the coagulopathic state of the patient from massive resuscitation or the inability to get the product directly to the source of hemorrhage. When the QuikClot was applied on responsive patients, the heat generated by the exothermic reaction caused mild to severe pain and discomfort. There were three cases of burns caused by the heat generated by the QuikClot application with one case requiring skin grafting. There was one major complication from intracorporeal use caused by scar formation from a foreign body reaction.

Conclusions: QuikClot has been effectively used by a wide range of providers in the field and hospital to control hemorrhage.

From the Department of Surgery (P.R.), University of Arizona, Tucson, Arizona; Department of Surgery (C.B.), Brackenridge Hospital, Austin, Texas; Department of Surgery (M.M., D.P., D.G., L.C., D.D.), Los Angeles County Medical Center + University of Southern California, Los Angeles, California; Department of Surgery (A.S.), Cedars Sinai, Los Angeles, California; and Department of Surgery, (G.V., H.A.), Massachusetts General Hospital, Boston, Massachusetts.

Submitted for publication July 27, 2006.

Accepted for publication June 1, 2007.

The opinions and assertions contained herein are the private ones of the authors and are not to be construed as official or reflecting the views of the Department of Defense at large. This manuscript was prepared by United States Government employees and, therefore, cannot be copyrighted and may be copied with restriction.

Address for reprints: Peter Rhee, MD, MPH, Trauma, Critical Care and Emergency Surgery, University Medical Center, 1501 N. Campbell Ave., Tucson, AZ 85724; email: prhee@surgery.arizona.edu.

© 2008 Lippincott Williams & Wilkins, Inc.