An alternative hemostatic dressing: Comparison of CELOX, HemCon, and QuikClot

Buddy Kozen, Sara J. Kircher, Jose Henao, Fermin S. Godinez, Andrew S. Johnson

Research output: Contribution to journalArticle

Abstract

Objectives: Uncontrolled hemorrhage remains a leading cause of traumatic death. Several topical adjunct agents have been shown to be effective in controlling hemorrhage, and two, chitosan wafer dressing (HemCon [HC]) and zeolite powder dressing (QuikClot [QC]), are being utilized regularly on the battlefield. However, recent literature reviews have concluded that no ideal topical agent exists. The authors compared a new chitosan granule dressing (CELOX [CX]) to HC, QC and standard dressing in a lethal hemorrhagic groin injury. Methods: A complex groin injury with transection of the femoral vessels and 3 minutes of uncontrolled hemorrhage was created in 48 swine. The animals were then randomized to four treatment groups (12 animals each). Group 1 included standard gauze dressing (SD); Group 2, CX; Group 3, HC; and Group 4, QC. Each agent was applied with 5 minutes of manual pressure followed by a standard field compression dressing. Hetastarch (500 mL) was infused over 30 minutes. Hemodynamic parameters were recorded over 180 minutes. Primary endpoints included rebleed and death. Results: CX reduced rebleeding to 0% (p < 0.001), HC to 33% (95% CI = 19.7% to 46.3%, p = 0.038), and QC to 8% (95% CI = 3.3% to 15.7%, p = 0.001), compared to 83% (95% CI = 72.4% to 93.6%) for SD. CX improved survival to 100% compared to SD at 50% (95% CI = 35.9% to 64.2%, p = 0.018). Survival for HC (67%) (95% CI = 53.7% to 80.3%) and QC (92%; 95% CI = 84.3% to 99.7%) did not differ from SD. Conclusions: In this porcine model of uncontrolled hemorrhage, CX improved hemorrhage control and survival. CELOX is a viable alternative for the treatment of severe hemorrhage.

Original languageEnglish (US)
Pages (from-to)74-81
Number of pages8
JournalAcademic Emergency Medicine
Volume15
Issue number1
DOIs
StatePublished - Jan 1 2008

Fingerprint

Hemostatics
Bandages
Hemorrhage
Groin
Chitosan
Swine
Hydroxyethyl Starch Derivatives
Zeolites
Wounds and Injuries
Thigh
Powders
Cause of Death
Hemodynamics
Pressure

Keywords

  • CELOX
  • Chitosan
  • Hemostatic dressing
  • Uncontrolled hemorrhage
  • Zeolite

ASJC Scopus subject areas

  • Medicine(all)
  • Emergency Medicine

Cite this

An alternative hemostatic dressing : Comparison of CELOX, HemCon, and QuikClot. / Kozen, Buddy; Kircher, Sara J.; Henao, Jose; Godinez, Fermin S.; Johnson, Andrew S.

In: Academic Emergency Medicine, Vol. 15, No. 1, 01.01.2008, p. 74-81.

Research output: Contribution to journalArticle

Kozen, Buddy ; Kircher, Sara J. ; Henao, Jose ; Godinez, Fermin S. ; Johnson, Andrew S. / An alternative hemostatic dressing : Comparison of CELOX, HemCon, and QuikClot. In: Academic Emergency Medicine. 2008 ; Vol. 15, No. 1. pp. 74-81.
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abstract = "Objectives: Uncontrolled hemorrhage remains a leading cause of traumatic death. Several topical adjunct agents have been shown to be effective in controlling hemorrhage, and two, chitosan wafer dressing (HemCon [HC]) and zeolite powder dressing (QuikClot [QC]), are being utilized regularly on the battlefield. However, recent literature reviews have concluded that no ideal topical agent exists. The authors compared a new chitosan granule dressing (CELOX [CX]) to HC, QC and standard dressing in a lethal hemorrhagic groin injury. Methods: A complex groin injury with transection of the femoral vessels and 3 minutes of uncontrolled hemorrhage was created in 48 swine. The animals were then randomized to four treatment groups (12 animals each). Group 1 included standard gauze dressing (SD); Group 2, CX; Group 3, HC; and Group 4, QC. Each agent was applied with 5 minutes of manual pressure followed by a standard field compression dressing. Hetastarch (500 mL) was infused over 30 minutes. Hemodynamic parameters were recorded over 180 minutes. Primary endpoints included rebleed and death. Results: CX reduced rebleeding to 0{\%} (p < 0.001), HC to 33{\%} (95{\%} CI = 19.7{\%} to 46.3{\%}, p = 0.038), and QC to 8{\%} (95{\%} CI = 3.3{\%} to 15.7{\%}, p = 0.001), compared to 83{\%} (95{\%} CI = 72.4{\%} to 93.6{\%}) for SD. CX improved survival to 100{\%} compared to SD at 50{\%} (95{\%} CI = 35.9{\%} to 64.2{\%}, p = 0.018). Survival for HC (67{\%}) (95{\%} CI = 53.7{\%} to 80.3{\%}) and QC (92{\%}; 95{\%} CI = 84.3{\%} to 99.7{\%}) did not differ from SD. Conclusions: In this porcine model of uncontrolled hemorrhage, CX improved hemorrhage control and survival. CELOX is a viable alternative for the treatment of severe hemorrhage.",
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AU - Johnson, Andrew S.

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AB - Objectives: Uncontrolled hemorrhage remains a leading cause of traumatic death. Several topical adjunct agents have been shown to be effective in controlling hemorrhage, and two, chitosan wafer dressing (HemCon [HC]) and zeolite powder dressing (QuikClot [QC]), are being utilized regularly on the battlefield. However, recent literature reviews have concluded that no ideal topical agent exists. The authors compared a new chitosan granule dressing (CELOX [CX]) to HC, QC and standard dressing in a lethal hemorrhagic groin injury. Methods: A complex groin injury with transection of the femoral vessels and 3 minutes of uncontrolled hemorrhage was created in 48 swine. The animals were then randomized to four treatment groups (12 animals each). Group 1 included standard gauze dressing (SD); Group 2, CX; Group 3, HC; and Group 4, QC. Each agent was applied with 5 minutes of manual pressure followed by a standard field compression dressing. Hetastarch (500 mL) was infused over 30 minutes. Hemodynamic parameters were recorded over 180 minutes. Primary endpoints included rebleed and death. Results: CX reduced rebleeding to 0% (p < 0.001), HC to 33% (95% CI = 19.7% to 46.3%, p = 0.038), and QC to 8% (95% CI = 3.3% to 15.7%, p = 0.001), compared to 83% (95% CI = 72.4% to 93.6%) for SD. CX improved survival to 100% compared to SD at 50% (95% CI = 35.9% to 64.2%, p = 0.018). Survival for HC (67%) (95% CI = 53.7% to 80.3%) and QC (92%; 95% CI = 84.3% to 99.7%) did not differ from SD. Conclusions: In this porcine model of uncontrolled hemorrhage, CX improved hemorrhage control and survival. CELOX is a viable alternative for the treatment of severe hemorrhage.

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