title: The effects of QuikClot Combat Gauze on hemorrhage control in the presence of hemodilution and hypothermia.
abstract: Hemorrhage is the leading cause of death from trauma. Intravenous (IV) fluid resuscitation in these patients may cause hemodilution and secondary hemorrhage. In addition, hypothermia may interfere with coagulation. The purposes of this study were to compare the effectiveness QuikClot Combat Gauze (QCG) to a control group on hemorrhage in a hemodiluted, hypothermic model, and to determine the effects of IV volume resuscitation on rebleeding. This was a prospective, between subjects, experimental design. Yorkshire swine were randomly assigned to two groups: QCG (n = 13) or control (n = 13). The subjects were anesthetized. Hypothermia (temperature of ≤34.0 °C) was induced; 30% of their blood volume was exsanguinated. A 3:1 replacement of Lactated Ringer's was administered to dilute the remaining blood. The femoral artery and vein were transected. After 1 min of uncontrolled hemorrhage, QCG was placed into the wound followed by standard wound packing. The control group underwent the same procedures without QCG. After 5 min of manual pressure, a pressure dressing was applied. Following 30 min, the dressings were removed, and blood loss was calculated. For subjects achieving hemostasis, up to 5 L of IV fluid was administered or until bleeding occurred, which was defined as >2% total blood volume. The QCG had significantly less hemorrhage than the control (QCG = 30 ± 99 mL; control = 404 ± 406 mL) (p = .004). Further, the QCG group was able to tolerate more resuscitation fluid before hemorrhage (QCG = 4615 ± 1386 mL; control = 846 ± 1836) (p = .000).
authors.affiliation: US Army Graduate Program in Anesthesia, Department of the Army, Academy of Health Sciences, 3490 Forage Road, Fort Sam Houston, TX 78234-6130, USA.
authors.forename: Don
authors.initials: D
authors.lastname: Johnson
authors.affiliation: US Army Graduate Program in Anesthesia, Department of the Army, Academy of Health Sciences, 3490 Forage Road, Fort Sam Houston, TX 78234-6130, USA.
authors.forename: Sheri
authors.initials: S
authors.lastname: Bates
authors.affiliation: US Army Graduate Program in Anesthesia, Department of the Army, Academy of Health Sciences, 3490 Forage Road, Fort Sam Houston, TX 78234-6130, USA.
authors.forename: Sofiya
authors.initials: S
authors.lastname: Nukalo
authors.affiliation: US Army Graduate Program in Anesthesia, Department of the Army, Academy of Health Sciences, 3490 Forage Road, Fort Sam Houston, TX 78234-6130, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Staub
authors.affiliation: US Army Graduate Program in Anesthesia, Department of the Army, Academy of Health Sciences, 3490 Forage Road, Fort Sam Houston, TX 78234-6130, USA.
authors.forename: Aaron
authors.initials: A
authors.lastname: Hines
authors.affiliation: US Army Graduate Program in Anesthesia, Department of the Army, Academy of Health Sciences, 3490 Forage Road, Fort Sam Houston, TX 78234-6130, USA.
authors.forename: Taylor
authors.initials: T
authors.lastname: Leishman
authors.affiliation: US Army Graduate Program in Anesthesia, Department of the Army, Academy of Health Sciences, 3490 Forage Road, Fort Sam Houston, TX 78234-6130, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Michel
authors.affiliation: US Army Graduate Program in Anesthesia, Department of the Army, Academy of Health Sciences, 3490 Forage Road, Fort Sam Houston, TX 78234-6130, USA.
authors.forename: Dusti
authors.initials: D
authors.lastname: Sikes
authors.affiliation: Veteran Anesthesia Services, PLLC, San Antonio, TX 78269, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Gegel
authors.affiliation: US Army Graduate Program in Anesthesia, Department of the Army, Academy of Health Sciences, 3490 Forage Road, Fort Sam Houston, TX 78234-6130, USA.
authors.forename: James
authors.initials: J
authors.lastname: Burgert
keywords: Hemorrhage; Hemorrhage control; Hypothermia; Resuscitation; Shock