title: Efficacy of three topical hemostatic agents applied by medics in a lethal groin injury model.
abstract: BACKGROUND
  Advanced topical hemostatic agents are increasingly utilized to control traumatic hemorrhage. We sought to determine the efficacy of three chitosan based hemostatic agents in a lethal groin injury model when applied by combat medic first responders.
  
  
  METHODS
  After creation of a standardized femoral artery injury in a goat model, medics attempted hemorrhage control with standard gauze dressing followed by randomization to one of three hemostatic agents in this two tiered study. In the first tier, medics were randomized to either a chitosan based one-sided wafer (OS) or a dual-sided, flexible, roll (DS). In the second tier, medics were randomized to the flexible DS dressing or a chitosan powder (CP). Efficacy of gauze, each chitosan agent, proper application, and participant surveys were obtained and included for analysis using univariate techniques.
  
  
  RESULTS
  From January 2007 to June 2007, 55 (45%) DS, 36 (29%) OS, and 32 (26%) CP agents were used to treat 123 actively bleeding arterial injuries in 62 animals. Standard gauze failed to stop hemorrhage in 122 (99%) groins. Although all three chitosan agents were marginally effective at 2 min, the recommended time for application, hemostasis improved after 4 min. The DS dressing was the most effective, controlling hemorrhage 76% at 4 min. Of the failures, 3 (23%) DS and 9 (53%) OS were due to improper application. End-user survey results demonstrated that medics preferred the DS dressing 77% and 60% over the OS and CP, respectively.
  
  
  CONCLUSIONS
  Chitosan based bandages are significantly more effective at hemorrhage control compared to standard gauze field dressings. The dual-sided chitosan dressing demonstrated better hemorrhage control than the one-sided dressing and the chitosan powder, and was less likely to fail despite application errors.
authors.affiliation: Department of Surgery and the Andersen Simulation Center, Madigan Army Medical Center, Tacoma, Washington 98431, USA.
authors.forename: Vance Y
authors.initials: VY
authors.lastname: Sohn
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Eckert
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Martin
authors.forename: Zachary M
authors.initials: ZM
authors.lastname: Arthurs
authors.forename: Jason R
authors.initials: JR
authors.lastname: Perry
authors.forename: Alec
authors.initials: A
authors.lastname: Beekley
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Rubel
authors.forename: Richard P
authors.initials: RP
authors.lastname: Adams
authors.forename: Gerald L
authors.initials: GL
authors.lastname: Bickett
authors.forename: Robert M
authors.initials: RM
authors.lastname: Rush