The Efficacy of QuikClot Combat Gauze, Fluid Resuscitation and Movement on Hemorrhage Control in a Porcine Model of Hypothermia
Brian Gegel *
Veteran Anesthesia Services, PLLC, San Antonio, TX 78269, USA and US Army Graduate Program in Anesthesia Nursing, Fort Sam Houston, TX 78234, USA.
James Burgert
US Army Graduate Program in Anesthesia Nursing, Fort Sam Houston, TX 78234, USA.
John Gasko
Star Anesthesia, P.A., San Antonio, TX 78216, USA
Sabine Johnson
The Geneva Foundation, Tacoma, WA 98402, USA.
Jennifer Florez
US Army Graduate Program in Anesthesia Nursing, Fort Sam Houston, TX 78234, USA.
E. Edward Dunton II
US Army Graduate Program in Anesthesia Nursing, Fort Sam Houston, TX 78234, USA.
Don Johnson
US Army Graduate Program in Anesthesia Nursing, Fort Sam Houston, TX 78234, USA.
*Author to whom correspondence should be addressed.
Abstract
Aims: The purpose of this study was to compare the effectiveness QuikClot Combat Gauze (QCG) to a control group on hemorrhage control and investigate the effects of intravenous volume resuscitation on rebleeding and movement on hemostasis in a porcine model of hypothermia.
Design: This was a prospective, between subjects, experimental design. Twenty-two Yorkshire swine were randomly assigned to two groups: QCG (n = 11) or control (n=11).
Methods: The femoral artery and vein were transected. After 1 minute of uncontrolled hemorrhage, the hemostatic agent QCG was placed into the wound followed by standard wound packing. The control group underwent the same procedures without QCG. After 5 minutes of manual pressure, a pressure dressing was applied to the injury site. Initial resuscitation was performed with 500 mL of rapidly administered IV 6% Hetastarch. Following 30 minutes of observation, the dressings were removed and any additional blood loss was collected and total blood loss calculated. Hemostasis was defined as <2% total blood volume or ~ 100 mL in a 70 kg swine. If hemostasis occurred, 5 Liters of IV crystalloid were rapidly administered and the wound was again observed for rebleeding. If no bleeding occurred, the extremity on the side of the injury was systematically moved through flexion, extension, abduction and adduction sequentially 10 times or until rebleeding occurred.
Results: There were significant differences in hemorrhage (P=.01), the amount of volume resuscitation (P =.01) and movement (P =.03) between the QCG and control groups.
Conclusion: QCG is effective and statistically superior at controlling hemorrhage, allows for greater fluid resuscitation, and tolerates significant movement without rebleeding compared to the standard pressure dressing control in this hypothermic porcine model of uncontrolled hemorrhage.
Keywords: Hypothermia, hemorrhage control, hemostatic agents, Quikclot combat gauze.