Kaolin-based hemostatic dressing improves hemorrhage control from a penetrating inferior vena cava injury in coagulopathic swine

Koko, Kiavash R.; McCauley, Brian; Gaughan, John; Nolan, Ryan S.; Fromer, Marc W.; Hagaman, Ashleigh L.R.; Choron, Rachel L.; Brown, Spencer A.; Hazelton, Joshua P.

doi:10.1097/ta.0000000000001492

Cited by 7 publications

(5 citation statements)

References 21 publications

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“…BZG is a zeolite-based bio-inorganic hybrid hemostatic gauze with a surface Ca ion exchange rate of 87%, which can promote the conversion of prothrombin from normal plasma and factor X de cient plasma to thrombin [16,17]. In contrast, kaolin is the main hemostatic component of QCG and exerts its hemostatic effect through activating the endogenous coagulation pathway [12,21]. When TIC occurs, the level of coagulation factor XII and the activation e ciency of the endogenous activation pathway decrease, resulting in a decrease in the hemostatic effect of QCG; while the decreased level of coagulation factor X will further decrease the hemostatic effect of QCG.…”

Section: Discussionmentioning

confidence: 99%

Comparative observations of the hemostatic effects of bio-zeolite gauze and QuickClot Combat Gauze on massive hemorrhage with coagulopathy

Yang

Jia

Xiao³

et al. 2023

Preprint

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BACKGROUND The presence of coagulopathy after bleeding negatively affects the hemostatic effects of gauze. In this study, we compared the hemostatic effects of bio-zeolite gauze (BZG) and QuickClot Combat Gauze (QCG) on massive hemorrhage complicated by coagulopathy. Methods In 30 rabbits, diluted coagulopathy was prepared by extraction of blood at a dose of 15 mL/kg body weight following infusion with saline three times the volume of blood loss. Then, simulated blast-induced pelvic injury was initiated to produce massive hemorrhage using a custom-made machine, as previously reported. The rabbits were then randomly allocated to three groups, namely A, B, and C, in which BZG, QCG, and ordinary gauze were used to prevent bleeding, respectively. The primary outcomes, including the immediate hemostasis rate, blood loss, and survival rate, were recorded at designated time points. Additionally, blood samples were taken for laboratory examinations, including conventional coagulation, thromboelastography, full blood count, blood biochemistry, and enzyme-linked immunosorbent assay. Results Animal models of diluted coagulopathy and major bleeding were successfully developed with decreased concentrations of coagulation factors XII and X. The overall effects of BZG were better than those of QCG and ordinary gauze, with a higher immediate hemostatic rate, less blood loss at 10 min and 30 min after gauze application, and higher red blood cell and platelet counts, higher maximum amplitude, lower R values, lower levels of creatinine, and lower levels of alanine aminotransferase at 30 min after gauze application. Furthermore, a higher survival rate was found in group A rabbits than in group B and group C rabbits at 90 min after gauze application. Conclusions BZG demonstrated better hemostatic performance than QCG and normal gauze for massive hemorrhage complicated by coagulopathy. BZG is a suitable hemostatic gauze for control of massive hemorrhage complicated by coagulopathy.

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Section: Discussionmentioning

confidence: 99%

Comparative observations of the hemostatic effects of bio-zeolite gauze and QuickClot Combat Gauze on massive hemorrhage with coagulopathy

Yang

Jia

Xiao³

et al. 2023

Preprint

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“…Previous versions of kaolin-impregnated gauze have been used as a packing adjunct during damage control laparotomies [4][5][6]. C+ applies kaolin more effectively than previous iterations and is rated for internal use.…”

Section: Discussionmentioning

confidence: 99%

Use of Kaolin-Impregnated Gauze Aids in Hemostasis and Blood Loss Mitigation in a Penetrating Injury to the Bladder and Small Bowel

Campbell,

Castater,

Smith

et al. 2023

Cureus

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Hemorrhage control can be technically challenging in penetrating injuries to the pelvis. In an era of decreased availability of blood, rapid hemostasis is critical to minimize blood loss, limit transfusions, and control contamination from hollow viscus injuries. QuikClot Control+® 12x12 Hemostatic Device(C+) (Teleflex Medical OEM, Plymouth, MN), a form of kaolin-impregnated gauze, maybe a helpful adjunct to ebb the flow of hemorrhage from large surface area wounds. We present a case in which C+ was utilized in the preperitoneal packing of a gunshot wound to the pelvis and aided in obtaining hemostasis while simultaneously allowing the team time to complete the remainder of the case. Though further large randomized control trials are required to identify the role of C+ in trauma laparotomy, it remains a tool in the surgeon’s armamentarium when dealing with hemorrhage.

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“…The QCC+, kaolin-based, sterile, x-ray detectable, nonwoven hemostatic dressing, is the first nonresorbable device indicated for temporary control of severe to life-threatening internal organ space bleeding and has demonstrated effective hemostasis. 13 The procoagulant kaolin, an aluminum silicate impregnated into the gauze, activates Factor XII on the intrinsic coagulation pathway, which in turn accelerates the clotting cascade. 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 The novel kaolin binding on QCC+ minimizes eluting from the product, particularly important for internal bleeding.…”

Section: Methodsmentioning

confidence: 99%

“…Previous studies have demonstrated positive results for control of visceral hemorrhage after using QCC+/QCCG. 13 , 14 Koko and colleagues 13 demonstrated that use of QCC+ in a penetrating retrohepatic inferior vena cava injury porcine model improved hemorrhage control and significantly decreased blood loss over laparotomy sponges. A preclinical safety study of QCC+ versus standard gauze in a porcine model evaluated treatment of bleeding from suture lines on incisional surgical wounds in the carotid and femoral arteries, as well as epicardial lacerations (performed while the animal was on bypass).…”

mentioning

confidence: 99%

Safety and efficacy of a kaolin-impregnated hemostatic gauze in cardiac surgery: A randomized trial

et al. 2023

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Kaolin-based hemostatic dressing improves hemorrhage control from a penetrating inferior vena cava injury in coagulopathic swine

Abstract: This is basic science research based on a large animal model, level V.

Cited by 7 publications

References 21 publications

Comparative observations of the hemostatic effects of bio-zeolite gauze and QuickClot Combat Gauze on massive hemorrhage with coagulopathy

Comparative observations of the hemostatic effects of bio-zeolite gauze and QuickClot Combat Gauze on massive hemorrhage with coagulopathy

Use of Kaolin-Impregnated Gauze Aids in Hemostasis and Blood Loss Mitigation in a Penetrating Injury to the Bladder and Small Bowel

Safety and efficacy of a kaolin-impregnated hemostatic gauze in cardiac surgery: A randomized trial

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