Systematic review of prehospital haemostatic dressings

Abstract

IntroductionHaemorrhage is one of the leading causes of battlefield and prehospital death. Haemostatic dressings are an effective method of limiting the extent of bleeding and are used by military forces extensively. A systematic review was conducted with the aim of collating the evidence on current haemostatic products and to assess whether one product was more effective than others.MethodsA systematic search and assessment of the literature was conducted using 13 health research databases including MEDLINE and CINAHL, and a grey literature search. Two assessors independently screened the studies for eligibility and quality. English language studies using current-generation haemostatic dressings were included. Surgical studies, studies that did not include survival, initial haemostasis or rebleeding and those investigating products without prehospital potential were excluded.Results232 studies were initially found and, after applying exclusion criteria, 42 were included in the review. These studies included 31 animal studies and 11 clinical studies. The outcomes assessed were subject survival, initial haemostasis and rebleeding. A number of products were shown to be effective in stopping haemorrhage, with Celox, QuikClot Combat Gauze and HemCon being the most commonly used, and with no demonstrable difference in effectiveness.ConclusionsThere was a lack of high-quality clinical evidence with the majority of studies being conducted using a swine haemorrhage model. Iterations of three haemostatic dressings, Celox, HemCon and QuikClot, dominated the studies, probably because of their use by international military forces and all were shown to be effective in the arrest of haemorrhage.

A Narrative Review of Different Hemostatic Materials in Emergency Treatment of Trauma

“…ere are many kinds of hemostatic materials [10][11][12][13][14][15][16][17], which can be divided into patch type (including gauze, nonwoven fabric, filaments, sponges, and membranes), particle powder type (including mineral hemostatic particles and hemostatic powders), fluid sealing type (including biological glue, chemical glue, wax, and liquid foam), and tactile expansion type (including compressed cotton and solid glue). e hemostatic materials shall have the characteristics of rapid hemostasis, no allergen, nontoxic degradation products, and can be absorbed by human body.…”

“…absorbing Particles Figure 2: e small particle structure of hemostatic powder absorbs the water in the blood, effectively concentrates the blood, and closely fits with the damaged tissue under the action of external forces, while with the help of some positively charged components such as chitosan, electrostatic effect occurs with negatively charged red blood cells, prompting the local formation of blood clots to accelerate hemostasis. hemostatic powder to absorb water in blood, effectively concentrate blood, closely adhere to damaged tissues under the action of external forces, and electrostatically interact with negatively charged red blood cells with the help of some self-positively charged components such as chitosan, so as to promote the formation of local blood clots and accelerate hemostasis [13] (Figure 2).…”

Hemostatic agents for prehospital hemorrhage control: a narrative review

“…Numerous studies have been conducted to compare local hemostatic agents mainly in animal hemorrhagic models [20,203,204]. Swine models of femoral arterial or mixed arterial and venous hemorrhage and an extremity injury with mixed arteriovenous hemorrhage and a large soft tissue component have mostly been used in the recent comparative studies of operationally deployed hemostatic agents [205,206].…”

“…Despite these great successes, there are safety concerns with the prehospital or in-combat use of local hemostatic agents [30,135,205]. Although no adverse events have been reported in human studies with the use of Combat Gauze, HemCon, Celox Gauze, Celox granules, ChitoGauze and QuikClot ACS+ [54,204], these studies are relatively short-term observational studies. Animal studies raised concerns with the presence of intraluminal particles and thrombi as well as tissue damage 2 to 3 h after treatment when WoundStat, super quick relief (another mineral-based hemostat composed of potassium iron oxyacid salt and hydrophilic polymer) and Celox were compared against HemCon, QuikClot ACS+ and Combat Gauze [31,220].…”

A Bioinspired Hemostatic Powder Derived from the Skin Secretion ofAndrias davidianusfor Rapid Hemostasis and Intraoral Wound Healing

“…Although Celox (chitosan as the main ingredient) [7] has overcome the above problems, [8,9] due to its poor adhesion and relatively slow degradable nature, must be washed away by water, possibly causing additional blood loss, especially in the case of visceral hemorrhage. [10] Zeolites not only easily enter the capillaries leading to thrombosis, but they also have the tendency to absorb water and produce heat, causing damage to the skin. [11] Arista (starch microspheres) stops bleeding mainly by rapid water-absorption and swelling, which is insufficient in controlling severe internal bleeding.…”