title: An alternative hemostatic dressing: comparison of CELOX, HemCon, and QuikClot.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Emergency Medicine, Naval Medical Center, Portsmouth, VA, USA. bkozen1@jhmi.edu
authors.forename: Buddy G
authors.initials: BG
authors.lastname: Kozen
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Kircher
authors.forename: Jose
authors.initials: J
authors.lastname: Henao
authors.forename: Fermin S
authors.initials: FS
authors.lastname: Godinez
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Johnson
mesh_terms: D000818:Animals; D001458:Bandages; D001794:Blood Pressure; D001831:Body Temperature; D048271:Chitosan / Q000008:administration & dosage; D004195:Disease Models, Animal; D005260:Female; D006119:Groin / Q000293:injuries; D006470:Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D006490:Hemostatics / Q000008:administration & dosage*; D008887:Military Medicine / Q000295:instrumentation; D011208:Powders; D011897:Random Allocation; D013552:Swine; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000150:complications; D017641:Zeolites / Q000008:administration & dosage
chemical_list: D006490:Hemostatics; D011208:Powders; D017641:Zeolites; D048271:Chitosan