title: Comparison of Topical Hemostatic Agents in a Swine Model of Extremity Arterial Hemorrhage: BloodSTOP iX Battle Matrix vs. QuikClot Combat Gauze.
abstract: BloodSTOP iX Battle Matrix (BM) and QuikClot Combat Gauze (CG) have both been used to treat traumatic bleeding. The purpose of this study was to examine the efficacy and initial safety of both products in a swine extremity arterial hemorrhage model, which mimics combat injury. Swine (37.13 ± 0.56 kg, NBM = 11, NCG = 9) were anesthetized and splenectomized. We then isolated the femoral arteries and performed a 6 mm arteriotomy. After 45 s of free bleeding, either BM or CG was applied. Fluid resuscitation was provided to maintain a mean arterial pressure of 65 mmHg. Animals were observed for three hours or until death. Fluoroscopic angiography and wound stability challenge tests were performed on survivors. Tissue samples were collected for histologic examination. Stable hemostasis was achieved in 11/11 BM and 5/9 CG subjects, with recovery of mean arterial pressure and animal survival for three hours (p < 0.05, Odds Ratio (OR) = 18.82 (0.85-415.3)). Time to stable hemostasis was shorter for the BM-treated group (4.8 ± 2.5 min vs. 58 ± 20.1 min; Median = 2, Interquartile Range (IQR) = 0 min vs. Median = 60, IQR = 120 min; p < 0.05) and experienced longer total stable hemostasis (175.2 ± 2.5 min vs. 92.4 ± 29.9 min; Median = 178, IQR = 0 min vs. Median = 120, IQR = 178 min; p < 0.05). Post-treatment blood loss was lower with BM (9.5 ± 2.4 mL/kg, Median = 10.52, IQR = 13.63 mL/kg) compared to CG (29.9 ± 9.9 mL/kg, Median = 29.38, IQR = 62.44 mL/kg) (p = 0.2875). Standard BM products weighed less compared to CG (6.9 ± 0.03 g vs. 20.2 ± 0.4 g) (p < 0.05) and absorbed less blood (3.4 ± 0.8 g vs. 41.9 ± 12.3 g) (p < 0.05). Fluoroscopic angiography showed recanalization in 5/11 (BM) and 0/5 (CG) surviving animals (p = 0.07, OR = 9.3 (0.41-208.8)). The wound stability challenge test resulted in wound re-bleeding in 1/11 (BM) and 5/5 (CG) surviving animals (p < 0.05, OR = 0.013 (0.00045-0.375)). Histologic evidence indicated no wound site, distal limb or major organ damage in either group. BM is more effective and portable in treating arterial hemorrhage compared to CG. There was no histologic evidence of further damage in either group.
authors.affiliation: Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, CA 94143, USA. huixi.li@ucsf.edu.
authors.forename: Huixi
authors.initials: H
authors.lastname: Li
authors.affiliation: Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, CA 94143, USA. lin.wang@ucsf.edu.
authors.forename: Lin
authors.initials: L
authors.lastname: Wang
authors.affiliation: Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, CA 94143, USA. amjadwal@yahoo.com.
authors.forename: Amjad
authors.initials: A
authors.lastname: Alwaal
authors.affiliation: Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, CA 94143, USA. leeyc12345@yahoo.com.tw.
authors.forename: Yung-Chin
authors.initials: YC
authors.lastname: Lee
authors.affiliation: Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, CA 94143, USA. amanda.reed-maldonado@ucsf.edu.
authors.forename: Amanda
authors.initials: A
authors.lastname: Reed-Maldonado
authors.affiliation: VDx Veterinary Diagnostics, Davis, CA 95616, USA. tspangler@vdxpathology.com.
authors.forename: Taylor A
authors.initials: TA
authors.lastname: Spangler
authors.affiliation: Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, CA 94143, USA. lia.banie@ucsf.edu.
authors.forename: Lia
authors.initials: L
authors.lastname: Banie
authors.affiliation: Department of Aeromedical Research, U.S. Air Force School of Aerospace Medicine, Wright-Patterson Air Force Base, Dayton, OH 45433, USA. reginald.ohara@yahoo.com.
authors.forename: Reginald B
authors.initials: RB
authors.lastname: O'Hara
authors.affiliation: Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, CA 94143, USA. glin@urology.ucsf.edu.
authors.forename: Guiting
authors.initials: G
authors.lastname: Lin
mesh_terms: D000792:Angiography; D000818:Animals; D004195:Disease Models, Animal; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000293:injuries*; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000628:therapy*; D006490:Hemostatics / Q000627:therapeutic use*; D009779:Occlusive Dressings; D016019:Survival Analysis; D034421:Sus scrofa; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics
keywords: BloodSTOP Battle Matrix; QuikClot Combat Gauze; hemorrhage control; hemostatic agents; swine