Hemostatic Control Agents, Update

**The Reaper** · 12-21-2006, 14:25

Gents:

Not a medic, but I recently stayed at a Holiday Inn Express. I also watched the briefing at SOMA by the project officer for HCAs.

The Navy recently tested four HCAs, and Celox came out on top. It was among the best at stopping bleeding, is relatively inexpensive, does not create the exothermic burns that at least one other does, was relatively good at maintaining control during patient movement and handling, and finally, was the easiest to clean out of the wound during debridement and closure (rinse out with no ill-effects).

I believe that if long term studies were done including the post-incident recovery of patients after Quick Clot, it would be pulled from the market, or at least severaly limited in use. Anyone who opens a pack in a windy environment is going to create some problems as well. In a helicopter, it could be terminal. Users need to understand that it is a last resort, to be used only if other measures, like direct compression with packing for five minutes have failed.

I think that the Navy study is among the best, looking at the right primary factors (total blood loss and mortality) with few axes to grind or sponsors to protect.

Hope this is of value.

TR

x SF med · 12-21-2006, 14:47

TR,
Condolences for staying at a Holiday Inn Express, I thought that was NDDs job. Did you remember to bring your own bed linens (poncho liner and plastic sheeting so the bedbugs don't get you)?

Otherwise, thanks for the post, great info.

mugwump · 12-21-2006, 15:47

Thanks for this, very interesting. This stuff is cheap, $15 per packet retail as compared with $170 for the HemCon hemostatic bandage. Both use chitosan to control bleeding but the Celox looks even better for penetrating wounds. For $30 retail you can add a packet of this stuff and an Israeli bandage to a first aid kit.

When I Googled "chitosan" I found a zillion hits for its use as a dietary supplement for weight loss ("fat magnet"). It doesn't work, apparently, but it looks like the price of bulk chitosan has been driven down by the fad.

Any discussion about Hemopure, the blood substitute the Navy is backing? Now that PolyHeme has fallen out of bed it looks like the only game in town. I think if they are going to get Hemopure off the ground they are going to have to sponsor their own clinical studies.

**The Reaper** · 12-21-2006, 15:53

Quote:

Originally Posted by mugwump

Thanks for this, very interesting. This stuff is cheap, $15 per packet retail as compared with $170 for the HemCon hemostatic bandage. Both use chitosan to control bleeding but the Celox looks even better for penetrating wounds. For $30 retail you can add a packet of this stuff and an Israeli bandage to a first aid kit.

When I Googled "chitosan" I found a zillion hits for its use as a dietary supplement for weight loss ("fat magnet"). It doesn't work, apparently, but it looks like the price of bulk chitosan has been driven down by the fad.

Any discussion about Hemopure, the blood substitute the Navy is backing? Now that PolyHeme has fallen out of bed it looks like the only game in town. I think if they are going to get Hemopure off the ground they are going to have to sponsor their own clinical studies.

The HemCon is great for sealing clean lacerations, but in irregular wounds it periodically can (and does) fails catastrophically. The Celox can be dumped into the wound and packed with Kerlix gauze, working almost as well as the QuickClot, without cooking the meat.

Didn't see anything on the blood substitutes.

TR

swatsurgeon · 12-22-2006, 14:34

This past year I attended a Trauma conference where Peter Rhee (Navy?) showed a video from the sand box...He's a surgeon and he clearly showed the hemcon 'pads' do not conform to an irregular wound, hence, lack of efficacy. The celox and new Arista (repackaged TraumaDex/Hemaderm by Medafor) are way ahead of the curve. We are using the Arista/TraumaDex in the operating room now and so far I'm happy. My next use will be into a bleeding bullet tract to see how it doed in the trauma resuscitation bay, then bring them to the operating room and check the results. This will as closely mimic the first responder pushing this stuff into a bad wound that you can't get 'direct 'pressure on but some sort of pressure and see what happens.
I'll post as soon as I have one...I'm on call for the next 4 days straight so maybe I'll get to use it this way.

ss

TR and company.....I agree with if NOTHING ELSE WORKS and all you have left is quikclot, well, then there is little to lose but it is at the VERY BOTTOM of my list of tricks for hemorrhage control.

**The Reaper** · 12-22-2006, 14:48

Thanks, SS.

We have also had decent results with Fast Act, but for some reason, it has been spotty in previous tests.

Neatest thing is that it comes in a foam spray can, you can get it down deep into a wound.

mugwump, I agree wholeheartedly. These are all tools in the kit bag. The best solution is to have as many of them as possible available, and to choose the right one for the job. After hearing the Navy's results, I decided that Celox was going into my personal kit. As you noted, it is too inexpensive to pass up. The real scary expensive one is the Fibrin bandage from the Red Cross. Anyone else seem to think that they enjoy having a monopoly on the blood and blood products market?

TR