Comparison of Celox Gauze haemostat with kaolin based gauze

Objectives: Uncontrolled hemorrhage remains a leading cause of traumatic death. Several topicaladjunct agents have been shown to be effective in controlling hemorrhage, and two, chitosan waferdressing (HemCon [HC]) and zeolite powder dressing (QuikClot [QC]), are being utilized regularly on thebattlefield. However, recent literature reviews have concluded that no ideal topical agent exists. Theauthors compared a new chitosan granule dressing (CELOX [CX]) to HC, QC and standard dressing in alethal hemorrhagic groin injury. Methods: A complex groin injury with transection of the femoral vessels and 3 minutes of uncontrolledhemorrhage was created in 48 swine. The animals were then randomized to four treatment groups (12animals each). Group 1 included standard gauze dressing (SD); Group 2, CX; Group 3, HC; and Group 4,QC. Each agent was applied with 5 minutes of manual pressure followed by a standard field compres-sion dressing. Hetastarch (500 mL) was infused over 30 minutes. Hemodynamic parameters wererecorded over 180 minutes. Primary endpoints included rebleed and death. Results: CX reduced rebleeding to 0% (p < 0.001), HC to 33% (95% CI = 19.7% to 46.3%, p = 0.038),and QC to 8% (95% CI = 3.3% to 15.7%, p = 0.001), compared to 83% (95% CI = 72.4% to 93.6%) for SD.CX improved survival to 100% compared to SD at 50% (95% CI = 35.9% to 64.2%, p = 0.018). Survivalfor HC (67%) (95% CI = 53.7% to 80.3%) and QC (92%; 95% CI = 84.3% to 99.7%) did not differ fromSD. Conclusions: In this porcine model of uncontrolled hemorrhage, CX improved hemorrhage control andsurvival. CELOX is a viable alternative for the treatment of severe hemorrhage. ACADEMIC EMERGENCY MEDICINE 2008; 15:74–81 a 2008 by the Society for Academic EmergencyMedicine