Topical hemostatic agents and dressings in the prehospital setting

Abstract

Efficacy of currently available hemostatic agents and dressings appears to have plateaued in recent years although new agents and delivery mechanisms under development may improve control in cases of severe hemorrhage.

Hemostatic Efficacy of Local “Chitosan Linear Polymer” Granule in an Experimental Sheep Model with Severe Bleeding of Arteria and Vena Femoralis

“…It is heavy enough to be poured into the wound without being rap- idly flushed away by ongoing bleeding or easily blown away in adverse weather conditions. [6,13,14,17,19,24,25,27,28,31,32] These properties approximate ideal qualities of hemostatic agents for prehospital and battlefield use. [10][11][12][13][14][15][16][17][18][19] Various hemostatic products have been tested in a number of animal models, ranging from liver to complex groin injuries, with disparate results, depending on the model and the standard of cost-effectiveness.…”

“…It can be argued that no agent has met all ideal criteria, though chitosan linear polymer may be a candidate. [6,7,10,13,17,19,24,25,27,28,31,32] The groin injury model presently utilized took into account realities of modern combat injuries, and has previously been tested. [1][2][3]13,15,16,27] Salient features include lethal but potentially salvageable injury, anatomic location unsuitable for application of tourniquet, combined arterial and venous injuries with uncontrolled hemorrhage, large soft tissue injury, realistic delays in application of dressing and start of resuscitation, and resuscitation approach consistent with new recommendations for the military.…”

“…[2,3,7,[18][19][20] While many local hemostatic agents have been tested, no clear consensus exists regarding optimal hemorrhage control strategy for external bleeding. [1,4,8,9,[13][14][15][16][17]20,[24][25][26][27][28][29][30] However, Pusateri and Grissom [10,19] outlined ideal qualities of hemostatic agents for prehospital and battlefield use.…”

“…Bleeding treated with blood phasizing the need for improvement in hemorrhage control therapy in the field and in combat hospitals. [17][18][19][20] In the past 1-15 years, significant research has been invested in developing new hemostatic agents to rapidly and securely stop severe incompressible bleeding that cannot be controlled with standard gauze dressing or tourniquet placement. Although tourniquets are vital in control of certain extremity injuries, efficacy in treating wounds in areas such as the neck, abdomen, or groin is limited or nil.…”

Effects of Microporous Polysaccharide Powder in a Model of Dilution on Viscoelastic Characteristics of Clot Formation - An In-Vitro Study

“…The use of these agents is common in the prehospital as well as in the hospital setting and application of topical haemostatics is well reported [9][10][11] .…”