The Use Of Celox^™Gauze as an Adjunct to Pelvic Packing in Otherwise Uncontrollable Pelvic Haemorrhage Secondary to Penetrating Trauma

Abstract

Haemorrhage from severe pelvic fractures can be associated with significant mortality. Modern civilian trauma centres may manage these injuries with a combination of external pelvic fixation, extra-peritoneal packing and/or selective angiography; however, military patterns of wounding are different and deployed medical facilities may be resource constrained. We report two successful instances of pelvic packing using chitosan impregnated gauze (Celox) when conventional surgical attempts at vascular control had failed. We conclude that pelvic packing should be considered early in patients with military pelvic trauma and major haemorrhage, as part of damage control surgery and that Celox gauze may be a useful adjunct. In our cases, the Celox gauze was easily removed after 24-48 hours without significant bowel adhesions and did not leave a residual phelgmon (of exudate or gel) that may predispose to infection.

Celox-Coated Gauze for the Treatment of Civilian Penetrating Trauma: A Randomized Clinical Trial

“…With the success celox has enjoyed in tactical circumstances, recent reports are emerging regarding its use in civilian medicine as well. Two such examples report utilization of this hemostatic agent for traumatic pelvic injury ( 14 ), and thoracic surgery ( 19 ). In our study celox gauze was used in a different setting (civilian ED) and for a different type of trauma, therefore, comparison is difficult if not impossible.…”

“…Since most of the available literature regarding celox is based on animal, lab, or military reports, and its role in civilian hospitals remains undefined ( 7 - 9 , 14 - 16 ), this trial aimed to evaluate the role of celox in the management of civilian penetrating trauma.…”

Bleeding Control Using Hemostatic Dressings: Lessons Learned

“…15 Additional peer-reviewed studies report successful outcomes using newer chitosan-based dressings (Celox Gauze, MedTrade Products Ltd, Crew, UK) in civilian hospital-based case reports [50][51][52] and prehospital (battlefield) case reports and series. 53,54 Furthermore, no complications or safety concerns have been noted in these cases or across many years of chitosan-based hemostatic dressing use (HemCon bandage and Celox granules) in either the military 55,56 or civilian prehospital sectors. 57 Based on the evidence-based literature review, the CoTCCC voted to add both Celox Gauze and ChitoGauze Pro (HemCon Medical Technologies, Portland, OR) to the TCCC Guidelines along with QuikClot Combat Gauze.…”

Topical hemostatic agents and dressings in the prehospital setting

“…Given the different models available to test hemostatic dressings, the US Army Institute of Surgical Research (USAISR) proposed a standardized swine junctional hemorrhage model for initial efficacy assessment of topical hemostatic agents to decrease the variability and interpretation of outcomes across these types of studies [20]. Not surprisingly, a lack of randomized controlled studies limits clinical data to mostly prehospital reports from combat and civilian settings based on observational and survey data [21][22][23][24][25][26][27][28][29][30]. Primary outcomes in this model include post-treatment blood loss, time period necessary for bleeding to stop, mean arterial pressure (MAP), survival time, and percentage survival.…”