Making sense of the preclinical literature on advanced hemostatic products.
A number of new hemostatic products have been developed recently for use in trauma settings of severe uncontrolled bleeding. Currently, the literature on these products is controversial, with efficacy demonstrated under some circumstances but not others. In this review, we analyze the current literature pertaining to four of the most promising products (dry fibrin sealant dressing, Rapid Deployment Hemostat, HemCon chitosan dressing, and QuikClot) that have been suggested for use in combat casualty care applications. In particular, this analysis takes into account the characteristics of the animal models used for efficacy testing of these products, the desired characteristics of hemostatic dressings, and specific safety considerations. Animal models ranged from those featuring low-pressure/low-flow bleeding to those featuring high-pressure/high-flow bleeding. When data are viewed in the context of the specific characteristics of the differing animal models used, seemingly disparate experimental results related to efficacy and safety become quite complementary and lead to recommendations for the use of different products in different injury scenarios. Mission and training requirements will dictate the use of these products by military and civilian prehospital care providers.
US Army Institute of Surgical Research, Fort Sam Houston, Texas 78234, and the Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA. anthony.pusateri@amedd.army.mil
Anthony E
AE
Pusateri
John B
JB
Holcomb
Bijan S
BS
Kheirabadi
Hasan B
HB
Alam
Charles E
CE
Wade
Kathy L
KL
Ryan
D000818:Animals; D001458:Bandages; D004195:Disease Models, Animal; D004353:Drug Evaluation, Preclinical; D004632:Emergency Medical Services; D006470:Hemorrhage / Q000188:drug therapy*; D006490:Hemostatics / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008889:Military Personnel; D009104:Multiple Trauma / Q000150:complications*; D016896:Treatment Outcome
D006490:Hemostatics