Comparison of ChitoFlex®, CELOX™, and QuikClot® in control of hemorrhage.
BACKGROUND
Exsanguinating extremity wounds remain the primary source of battlefield mortality. Operating forces employ three agents in Iraq: HemCon® (HemCon Medical Technologies, Inc., Portland, OR), QuikClot® (Z-Medica Corporation, Wallingford, CT), and CELOX™ (SAM Medical, Tualatin, OR). Anecdotal reports suggest that these agents are less useful on small entrance, linear-tract injuries. ChitoFlex® (HemCon Medical Technologies, Inc., Portland, OR) has been introduced but is untested.


OBJECTIVE
To compare the equivalency of the ChitoFlex® dressing, QuikClot® ACS+™ dressing, CELOX™, and standard gauze in their effectiveness to control bleeding from non-cavitary groin wounds.


METHODS
Forty-eight swine were randomly assigned to one of four treatment groups: standard gauze dressing (SD), ChitoFlex® dressing (CF), QuikClot® ACS+™ dressing (QC), and CELOX™ dressing (CX). A groin injury with limited vessel access was created in each animal. Subjects were resuscitated with 500 mL of hetastarch. The primary endpoint was 180-min survival. Secondary endpoints included total blood loss in mL/kg, incidence of re-bleeding, survival times among the animals that did not survive for 180 min, failure to achieve initial hemostasis, incidence of recurrent bleeding, time to initial re-bleeding, amount of re-bleeding, and mass of residual hematoma.


RESULTS
Survival occurred in 10 of 12 SD animals, 10 of 12 CF animals, 10 of 12 QC animals, and 9 of 12 CX animals. No statistically significant difference was found.


CONCLUSIONS
In our study of limited-access extremity bleeding, ChitoFlex® performed equally well in mitigating blood loss and promoting survival. The ChitoFlex® dressing is an equally effective alternative to currently available hemostatic agents. However, no agents were superior to standard gauze in our model of limited access.
Devlin
John J
JJ
Department of Emergency Medicine, Naval Medical Center, Portsmouth, Virginia 23708, USA.
Kircher
Sara
S
Kozen
Buddy G
BG
Littlejohn
Lanny F
LF
Johnson
Andrew S
AS
D000818:Animals; D001458:Bandages; D048271:Chitosan / Q000008:administration & dosage*; D004195:Disease Models, Animal; D005260:Female; D006119:Groin / Q000293:injuries; D006470:Hemorrhage / Q000517:prevention & control*; D006490:Hemostatics / Q000008:administration & dosage*; D008887:Military Medicine / Q000379:methods; D011446:Prospective Studies; D011897:Random Allocation; D034421:Sus scrofa; D014947:Wounds and Injuries / Q000628:therapy*
D006490:Hemostatics; D048271:Chitosan