A case Series Describing Thermal Injury Resulting From Zeolite Use for Hemorrhage Control in Combat Operations

McManus, John; Hurtado, Timothy R.; Pusateri, Anthony E.; Knoop, Kevin J.

doi:10.1080/10903120601021176

Cited by 53 publications

(37 citation statements)

References 11 publications

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“…In fact, the heat generated at the site of QC application has created concern over thermal injury to human tissue. 12 As has been seen in previous studies, 7,9,10 our experiment confirmed a quick, and relatively brief, increase in temperature to an average of 61.0°C. In recent months, Z-Medica has created a new formulation that reportedly does not employ a significant exothermic reaction.…”

Section: Discussionsupporting

confidence: 91%

“…[6][7][8][9][10] There have also been concerns related to side effects, specifically, thermal injury from the exothermic reaction associated with use of zeolite, [7][8][9][10][11] although documented occurrences are relatively infrequent. 12 Field use of these agents has reported some success in treating human wounds. 5 Overall, recent reviews of the existing literature suggest that there is no single perfect hemostatic dressing; each has its drawbacks and benefits.…”

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confidence: 99%

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An Alternative Hemostatic Dressing: Comparison of CELOX, HemCon, and QuikClot

Kozen

Kircher

Henao

et al. 2008

Academic Emergency Medicine

268

158

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Objectives: Uncontrolled hemorrhage remains a leading cause of traumatic death. Several topical adjunct agents have been shown to be effective in controlling hemorrhage, and two, chitosan wafer dressing (HemCon [HC]) and zeolite powder dressing (QuikClot [QC]), are being utilized regularly on the battlefield. However, recent literature reviews have concluded that no ideal topical agent exists. The authors compared a new chitosan granule dressing (CELOX [CX]) to HC, QC and standard dressing in a lethal hemorrhagic groin injury.Methods: A complex groin injury with transection of the femoral vessels and 3 minutes of uncontrolled hemorrhage was created in 48 swine. The animals were then randomized to four treatment groups (12 animals each). Group 1 included standard gauze dressing (SD); Group 2, CX; Group 3, HC; and Group 4, QC. Each agent was applied with 5 minutes of manual pressure followed by a standard field compression dressing. Hetastarch (500 mL) was infused over 30 minutes. Hemodynamic parameters were recorded over 180 minutes. Primary endpoints included rebleed and death.Results: CX reduced rebleeding to 0% (p < 0.001), HC to 33% (95% CI = 19.7% to 46.3%, p = 0.038), and QC to 8% (95% CI = 3.3% to 15.7%, p = 0.001), compared to 83% (95% CI = 72.4% to 93.6%) for SD. CX improved survival to 100% compared to SD at 50% (95% CI = 35.9% to 64.2%, p = 0.018). Survival for HC (67%) (95% CI = 53.7% to 80.3%) and QC (92%; 95% CI = 84.3% to 99.7%) did not differ from SD. Conclusions:In this porcine model of uncontrolled hemorrhage, CX improved hemorrhage control and survival. CELOX is a viable alternative for the treatment of severe hemorrhage.ACADEMIC EMERGENCY MEDICINE 2008; 15:74-81 ª

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Section: Discussionsupporting

confidence: 91%

mentioning

confidence: 99%

An Alternative Hemostatic Dressing: Comparison of CELOX, HemCon, and QuikClot

Kozen

Kircher

Henao

et al. 2008

Academic Emergency Medicine

268

158

View full text Add to dashboard Cite

show abstract

“…[73][74][75][76] However, their routine use in first aid cannot be recommended at this time because of significant variation in effectiveness by different agents and their potential for adverse effects, including tissue destruction with induction of a proembolic state and potential thermal injury (Class IIb, LOE B).…”

Section: Hemostatic Agentsmentioning

confidence: 99%

Part 17: First Aid

Markenson¹,

Ferguson²,

Chameides³

et al. 2010

Circulation

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“…Consensus on Science Evidence from 4 LOE 4 studies in adults [165][166][167][168] showed a significant improvement compared with standard treatment for out-of-hospital control of life-threatening bleeding when topical hemostatic agents were used by trained individuals. This beneficial outcome was supported by 21 LOE 5 animal studies.…”

Section: Fa-404b Fa-404c Fa-404dmentioning

confidence: 99%

Part 13: First Aid

Markenson¹,

Ferguson²,

Chameides³

et al. 2010

Circulation

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The International First Aid Science Advisory Board identified 38 questions in first aid practice that had not been subjected to an evidence review process or that needed to be updated since the 2005 process. Two or more members of the International First Aid Science Advisory Board volunteered to independently review the scientific literature and complete an evidence-based review worksheet summarizing the literature (see Part 2 of this supplement for additional information). After the evidence was presented to the full board, a draft consensus summary of the scientific evidence and a draft consensus treatment recommendation were developed and represented at a subsequent meeting. Thus, each question, evidence-based review, draft summary of science, and draft treatment recommendation was presented and discussed on 2 separate occasions, and a Consensus on Science and Treatment Recommendation was reached by the Board. This document is a report of the group's consensus.As in 2005, the worksheets revealed the continuing paucity of scientific evidence to support specific first aid interventions. Very little research is being conducted in first aid, and most of the recommendations are extrapolations from research and experience in other medical venues, animal studies, and case series. It is hoped that this document will be a stimulus to future research in first aid. First Aid for Medical Emergencies SummaryThe medical questions addressed include poisoning, anaphylaxis, oxygen administration, and aspirin administration for a suspected coronary event.No changes were recommended for first aid management of acute poisoning.In reviewing epinephrine administration for anaphylaxis, evidence was found that laypeople and some medical and prehospital professionals are unable to recognize the signs and symptoms of anaphylaxis and therefore cannot, without training, make an independent decision to administer epinephrine with an auto-injector or to administer a second dose if the first is not effective. This issue takes on added importance in view of legislation in some jurisdictions that permits these actions.No evidence was found, except in decompression injuries, to support the routine administration of oxygen by first aid providers.The administration of aspirin to a victim experiencing chest discomfort is problematic. The literature is clear on the benefit of early administration of aspirin in an acute coronary event, except when there is a clear contraindication, such as aspirin allergy or a bleeding disorder. Less clear, however, is whether first aid providers can recognize the signs and symptoms of an acute Consensus on ScienceThere are no human studies on the effect of treating oral caustic exposure with dilution therapy. One in vitro LOE 5 chemistry study 2 demonstrated no benefit from the addition of large volumes of diluent to either a strong base or a strong acid. Five LOE 5 animal studies 3-7 demonstrated histological benefit to the esophagus when a diluent was administered following exposure to an alkali or acid. Treat...

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A case Series Describing Thermal Injury Resulting From Zeolite Use for Hemorrhage Control in Combat Operations

Cited by 53 publications

References 11 publications

An Alternative Hemostatic Dressing: Comparison of CELOX, HemCon, and QuikClot

An Alternative Hemostatic Dressing: Comparison of CELOX, HemCon, and QuikClot

Part 17: First Aid

Part 13: First Aid

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