title: The effects of QuikClot Combat Gauze on hemorrhage control in the presence of hemodilution.
abstract: BACKGROUND
  Although hemostatic agents may be effective at stopping hemorrhage, they may fail because of hemodilution from intravenous fluids. The purpose of this study was to investigate the effects of QuikClot Combat Gauze (QCG) on rebleeding in a class II hemorrhage in the presence of hemodilution in a lethal femoral injury.
  
  
  METHODS
  This was a prospective experimental, between swine subjects design. Pigs were assigned to one of two groups: QCG (n=15) or control (n=15). Thirty percent of the pig's blood was exsanguinated and then a 3:1 ratio of ringers lactate was administered. A groin injury was created by transecting the femoral artery and vein to simulate a battlefield injury and allowed to bleed for one minute. After one minute of hemorrhage, proximal pressure was applied to the injury, and QCG was placed into the wound followed by standard wound packing. The control group underwent the same procedures with the exception of the hemostatic agent. For both groups, 5 minutes of direct pressure was applied to the wound followed by a standard pressure dressing. Dressings were removed after 30 minutes, and the amount of hemorrhage was calculated in milliliters for each group for a period of 5 minutes. An activated clotting time was used to exclude any pigs with coagulation pathology.
  
  
  RESULTS
  A multivariate analysis of variance indicated that there were no significant differences in the groups relative to weight, amount of one minute hemorrhage, fluid deficit replacement, blood volume, and the activated clotting time (P>.05) indicating that the groups were equivalent on these parameters. A t test indicated that there was significantly less bleeding (P=.002) in the QCG group (36 mL±112 mL) compared to the control group (340 mL±297 ml).
  
  
  CONCLUSIONS
  QCG produces a robust clot that can more effectively tolerate hemodilution compared to a control group.
authors.affiliation: US Army Graduate Program in Anesthesia, Fort Sam Houston, Texas, USA.
authors.forename: Don
authors.initials: D
authors.lastname: Johnson
authors.forename: Samantha
authors.initials: S
authors.lastname: Agee
authors.forename: Amanda
authors.initials: A
authors.lastname: Reed
authors.forename: Brian
authors.initials: B
authors.lastname: Gegel
authors.forename: James
authors.initials: J
authors.lastname: Burgert
authors.forename: John
authors.initials: J
authors.lastname: Gasko
authors.forename: Michael
authors.initials: M
authors.lastname: Loughren
mesh_terms: D000818:Animals; D001458:Bandages; D001792:Blood Platelets / Q000187:drug effects; D005263:Femoral Artery / Q000293:injuries; D006438:Hemodilution; D006470:Hemorrhage / Q000517:prevention & control*; D006490:Hemostatics / Q000627:therapeutic use*; D007616:Kaolin / Q000008:administration & dosage*; D015999:Multivariate Analysis; D011446:Prospective Studies; D013552:Swine
chemical_list: D006490:Hemostatics; D007616:Kaolin