Hemostatic agents for prehospital hemorrhage control: a narrative review

Abstract

Hemorrhage is the leading cause of preventable death in combat trauma and the secondary cause of death in civilian trauma. A significant number of deaths due to hemorrhage occur before and in the first hour after hospital arrival. A literature search was performed through PubMed, Scopus, and Institute of Scientific Information databases for English language articles using terms relating to hemostatic agents, prehospital, battlefield or combat dressings, and prehospital hemostatic resuscitation, followed by cross-reference searching. Abstracts were screened to determine relevance and whether appropriate further review of the original articles was warranted. Based on these findings, this paper provides a review of a variety of hemostatic agents ranging from clinically approved products for human use to newly developed concepts with great potential for use in prehospital settings. These hemostatic agents can be administered either systemically or locally to stop bleeding through different mechanisms of action. Comparisons of current hemostatic products and further directions for prehospital hemorrhage control are also discussed.

The Road to Survival for Haemodynamically Unstable Patients With Open Pelvic Fractures

“…Controversy surrounds the use of pelvic binding on lateral compression type injuries as they can become more haemodynamically unstable with the application of a binder due to the pelvis effectively collapsing inwards ( 27 ) and open pelvic fractures may also pose an impediment to binder application depending on the degree of soft tissue disruption. There are also a variety of haemostatic agents that can be used pre-hospital and during surgery to arrest bleeding including; systemic and topical haemostatic agents ( 24 , 28 ). Systemic haemostatic agents including; intravenous infusion of blood products, coagulation factors, and TXA, have become widely accepted, along with the guidance of a Haematologist to manage blood product administration in the haemorrhaging patient.…”

“…Topical haemostatics are used more in combat situations, these are more useful prehospital and are not as commonly employed as part of the surgical management of these patients. They include; dressings impregnated with haemostatic agents (Chitosan, Zeolite, Combat gauze, Quickclot, Kaolin impregnated gauze) and injectable and self-expanding sponges (Xstat-multiple radiopaque expanding mini-sponges) ( 24 , 28 ).…”

“…There is promise in the development of tissue engineering technology for application in the management of traumatic pelvic wounds to repair skin defects unable to be repaired using traditional techniques such as; autogenous flaps and bone, skin, and vessel grafts. Artificial skin, dermal substitutes, bioactive glasses, stem cell technology, and advanced wound dressings may bring hope to those suffering from chronic wounds and may prevent the formation of scar tissue during the healing process, promoting faster more effective wound coverage ( 24 , 28 , 46 ). This may also reduce morbidity from prolonged wound healing and infection causing sepsis.…”

Design and Preclinical Evaluation of Chitosan/Kaolin Nanocomposites with Enhanced Hemostatic Efficiency

“…Hemostatic dressings are regularly applied early after hemorrhage, irrespective of the cause, to reduce blood loss, until the patients receive the necessary medical care in the appropriate health care units. Currently, there are several hemostatic dressings that are either in the market or under development [ 2 , 3 , 4 , 5 ]. These dressing could be classified into polysaccharide-based (e.g., chitin/chitosan), zeolite/kaolin-based, dry fibrin sealant, microporous polysaccharide hemospheres, and hydrophilic polymers of potassium salts.…”

Formulation of a Topical Tannic Acid and Chitosan Gel Haemostatic Drug Delivery System for Treatment of Wounds and Abrasions

“…Coagulopathy, infection, hypothermia and organ failure are possible complications developing from acute blood loss [5]. Therefore, quick intervention in hemorrhagic control will result in better patient outcomes and a decreased demand for blood products [6]. Thus, topical haemostatic agents can play a major role in the emergency control of hemorrhage and could reduce the associated morbidity and mortality in life-threatening situations [7].…”