Emerging approaches to pre-hospital hemorrhage control: a narrative review

Abstract

In the United States, trauma claims the lives of over 150,000 civilians each year. In military settings, trauma and exsanguination result in 50% of combat related deaths. The majority of these deaths result from uncontrolled non-compressible hemorrhage. Non-compressible hemorrhage often results from deep vascular injuries within the torso, however can also occur secondary to penetrating injuries that involve the extremities. Given the high mortality rates for non-compressible hemorrhage, rapid and effective management of patients suffering from hemorrhage is essential to good patient outcomes. Consequently, there has been increasing interest in solutions for point-of-injury hemorrhage control in trauma and military medicine. Undoubtedly there is a great need for prehospital hemostatic interventions that can be deployed by trained and untrained personnel. Since 2001, various hemostatic agents have been developed, each with its advantages based upon the type and severity of injury, wound size, wound location, accessibility to injury site, and the coagulation status of the patient. These agents are often used in the military setting as a temporizing measure prior to definitive therapy and include techniques such as resuscitative endovascular balloon occlusion of the aorta (REBOA) and bioengineered agents including ResQFoam, RevMedx's XSTAT, Tranexamic acid (TXA), and QuikClot Combat Gauze (QCG). Here, we review the indications, composition, technique, efficacy, and outcomes of these hemostatic agents.

The effectiveness of Foley catheter balloon tamponade versus expanding sponges and hemostatic granules for catastrophic penetrating groin hemorrhage with small skin defect: a comparative study in a live tissue porcine model with evaluation of a concise training program

“…The XSTAT sponges rapidly expand in contact with blood to fill the wound cavity, causing compression of bleeding structures. 14 , 16 The price for one XSTAT 30 GEN 2 applicator is approximately 300 US dollars.…”

Advances in trauma care to save lives from traumatic injury: A narrative review

“…Nearly 90% of preventable deaths occur in the prehospital environment prior to arrival to advance medical care and surgical hemorrhage control 1 . Delivering transfusion capability to the prehospital scene shortens time to hemostasis 5 . Implementation of a prehospital blood program, while challenging from logistical and regulatory perspectives, is pragmatic, safe, and affords the opportunity to save lives 7 …”

“…These most severe patients have sustained greater injury loads and shock, with more inflammatory and immune activation, endotheliopathy, and infections. Techniques, transfusions and skills are moving from the hospital scene into the prehospital setting 5 . Alternative temporary hemostasis techniques are emerging, such as resuscitative endovascular balloon occlusion of the aorta (REBOA) 6 .…”

Flexible Bioactive Glass Nanofiber-Based Self-Expanding Cryogels with Superelasticity and Bioadhesion Enabling Hemostasis and Wound Healing

“…Thus, developing hemostatic agents enabling rapid and effective hemostasis is vital for subsequent therapy and improving patient outcomes. Various hemostatic products such as oxidized cellulose gauze (Surgicel), chitosan gauze (HemCon), gelatin sponge (Gelfoam), and gauze embedded with inorganic particles (QuikClot) have been developed and used in clinical practice. − Among them, inorganic material (i.e., zeolites and clays) based hemostats have been widely accepted in controlling massive hemorrhage without considerable toxicity. These inorganic hemostats usually function through two mechanisms: (i) facilitating plasma absorption and increasing blood cell concentration at the bleeding site, and (ii) promoting the coagulation cascade by negative surface charges and released ions (such as Ca 2+ ). − However, the hemostats based on zeolites and clays might lead to some adverse side effects or have some disadvantages.…”