Safety of the long-term application of QuikClot Combat Gauze, ChitoGauze PRO and Celox Gauze in a femoral artery injury model in swine – a preliminary study

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The purpose of this study was to examine the safety of the long-term application of QuikClot Combat Gauze, ChitoGauze PRO and Celox Gauze using a swine model. The study was conducted on nine pigs weighing approximately 30 kg, which were randomly divided into three groups. Under deep anesthesia, the pigs underwent complete transverse cutting of the femoral artery in the groin region. Hemostatic dressings were left in the wound for 24 hours. The animals were euthanized 24 hours after dressing application. In each group, macroscopic and microscopic severe changes and shock symptoms were observed in the lungs, liver, kidneys and heart. Fibrino-gaseous embolic material was found in the pulmonary artery of each group and in the lung vessels of the animals from the ChitoGauze PRO and Celox Gauze groups. In conclusion, the long-term application of the evaluated hemostatic dressings has the risk of coagulopathy and reaching the progressive stage of shock. The residues from the hemostatic dressings can ingress into the systemic circulation, thereby increasing the risk of embolus formation. Because of these harmful effects, the evaluated hemostatic dressings are not appropriate for long-term use. Future studies are needed on the consequences of the long-term application of these hemostatic agents.

Adamiak Z, Jastrzębski P, Pomianowski A, Otrocka-Domagała I, Holak P, Zhalniarovich Y, Przyborowska P, Głodek J (2014) Effect of 24 hour application of three hemostatic dressings to porcine thigh muscles. Pol J Vet Sci 17: 519-521.

Arnaud F, Teranishi K, Tomor T, Carr W, McCarron R (2009) Comparison of 10 hemostatic dressings in a groin puncture model in swine. J Vasc Surg. 50: 632-639.

Clay JG, Grayson JK, Zierold D (2010) Comparative testing of new hemostatic agents in a swine model of extremity arterial and venous hemorrhage. Mil Med 175: 280-284.

De Castro GP, Dowling MB, Kilbourne M, Keledjian K, Driscoll IR, Raghavan SR, Hess JR, Scalea TM, Bochicchio GV (2011) Determination of efficacy of novel modified chitosan sponge dressing in a lethal arterial injury model in swine. J Trauma 72: 899-907.

Gando S, Otomo Y (2015) Local hemostasis, immunothrombosis, and systemic disseminated intravascular coagulation in trauma and traumatic shock. Crit Care 19: 72.

Gegel B, Burgert J, Gasko J, Campbell C, Martens M, Keck J, Reynolds H, Loughren M, Johnson D (2012) The effects of QuikClot Combat Gauze and movement on hemorrhage control in a porcine model. Mil Med 177: 1543-1547.

Gerlach T, Grayson JK, Pichakron KO, Sena MJ, DeMartini SD, Clark BZ, Estep JS, Zierold D (2010) Preliminary study of the effects of smectite granules (WoundStat) on vascular repair and wound healing in a swine survival model. J Trauma 69: 1203-1209.

Gutierrez G, Reines HD, Wulf-Gutierrez ME (2004) Clinical review: hemorrhagic shock. Crit Care 8: 373-381.

Jastrzębski P, Adamiak Z, Pomianowski A, Krystkiewicz W, Holak P, Sawicki S, Przyborowska P, Zhalniarovich Y, Gudzbeler G (2014) Response of the coagulation system after application of hemostatic dressings in an animal model. Pol J Vet Sci 17: 725-727.

Johnson D, Bates S, Nukalo S, Staub A, Hines A, Leishman T, Michel J, Sikes D, Gegel B, Burgert J (2014) The effects of QuikClot Combat Gauze on hemorrhage control in the presence of hemodilution and hypothermia. Ann Med Surg (Lond) 3: 21-25.

Kheirabadi BS, Mace JE, Terrazas IB, Fedyk CG, Estep JS, Dubick MA, Blackbourne LH (2010) Safety evaluation of new hemostatic agents, smectite granules, and kaolin-coated gauze in a vascular injury wound model in swine. J Trauma 68: 269-278.

King DR (2011) Thirty consecutive uses of a hemostatic bandage at a US Army combat support hospital and forward surgical team in Operation Iraqi Freedom. J Trauma 71: 1775-1778.

Leandoer L, Bergentz SE (1970) Haemorrhagic shock in the dog. The formation of thromboemboli during antifibrinolytic therapy. Eur Surg Res 2: 341-347.

Li J, Cao W, LvXX, Jiang L, Li YJ, Li WZ, Chen SZ, Li XY (2013) Zeolite-based hemostat QuikClot releases calcium into blood and promotes blood coagulation in vitro. Acta Pharmacol Sin 34: 367-372.

Littlejohn LF, Devlin JJ, Kircher SS, Lueken R, Melia MR, Johnson AS (2011) Comparison of Celox-A, ChitoFlex, WoundStat, and combat gauze hemostatic agents versus standard gauze dressing in control of hemorrhage in a swine model of penetrating trauma. Acad Emerg Med 18: 340-350.

Millner R, Lockhart AS, Marr R (2010) Chitosan arrests bleeding in major hepatic injuries with clotting dysfunction: an in vivo experimental study in a model of hepatic injury in the presence of moderate systemic heparinisation. Ann R Coll Surg Engl 92: 559-561.

Mosier DA (2012) Vascular disorders and thrombosis. In: Zachary JF, McGavin MD (eds) Pathologic basis of veterinary disease, 5th ed. Mosby Elsevier, St Louis, Missouri, pp 60-86.

Murphy EJ, Roberts E, Horrocks LA (1993) Aluminum silicate toxicity in cell cultures. Neuroscience 55: 597-605.

Pusateri AE, Holcomb JB, Kheirabadi BS, Alam HB, Wade CE, Ryan KL (2006) Making sense of the preclinical literature on advanced hemostatic products. J Trauma 60: 674-682.

Wright JK, Kalns J, Wolf EA, Traweek F, Schwarz S, Loeffler CK, Snyder W, Yantis LD Jr, Eggers J (2004) Thermal injury resulting from application of a granular mineral hemostatic agent. J Trauma 57: 224-230.

Polish Journal of Veterinary Sciences

The Journal of Committee of Veterinary Sciences of Polish Academy of Sciences and University of Warmia and Mazury in Olsztyn

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IMPACT FACTOR 2016: 0.697
5-year IMPACT FACTOR: 0.773

CiteScore 2016: 0.73

SCImago Journal Rank (SJR) 2016: 0.315
Source Normalized Impact per Paper (SNIP) 2016: 0.486


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