QuikClot use in trauma for hemorrhage control: case series of 103 documented uses.
BACKGROUND
Local hemostatics have recently been introduced for field use to control external hemorrhage. The objective of this report is to describe the initial clinical experience with QuikClot, a zeolite that works by absorbing water and concentrating coagulation factors to stop bleeding in a series of patients.


METHODS
Documented cases using a self-reporting survey sheet submitted by the users and first-hand detailed interviews with the users when possible.


RESULTS
There were 103 documented cases of QuikClot use: 69 by the US military in Iraq, 20 by civilian trauma surgeons and 14 by civilian first responders. There were 83 cases involving application to external wounds and 20 cases of intracorporeal use by military and civilian surgeons. All field applications by first responders were successful in controlling hemorrhage. The overall efficacy rate was 92% with eight cases of ineffectiveness noted by physicians in morbid patients with massive injuries when the QuikClot was used as a last resort. These reported failures were thought to be a result of the coagulopathic state of the patient from massive resuscitation or the inability to get the product directly to the source of hemorrhage. When the QuikClot was applied on responsive patients, the heat generated by the exothermic reaction caused mild to severe pain and discomfort. There were three cases of burns caused by the heat generated by the QuikClot application with one case requiring skin grafting. There was one major complication from intracorporeal use caused by scar formation from a foreign body reaction.


CONCLUSIONS
QuikClot has been effectively used by a wide range of providers in the field and hospital to control hemorrhage.
Rhee
Peter
P
Department of Surgery, University of Arizona, Tucson, Arizona, USA. prhee@surgery.arizona.edu
Brown
Carlos
C
Martin
Matthew
M
Salim
Ali
A
Plurad
Dave
D
Green
Donald
D
Chambers
Lowell
L
Demetriades
Demetrios
D
Velmahos
George
G
Alam
Hassan
H
D001458:Bandages; D015331:Cohort Studies; D004638:Emergency Treatment / Q000379:methods; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006490:Hemostatics / Q000627:therapeutic use*; D006772:Hospitals, Military; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D009104:Multiple Trauma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D015996:Survival Rate; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000150:complications* / Q000175:diagnosis
D006490:Hemostatics