Effectiveness of hemostatic agents to control external bleeding in military health
Keywords:
advanced trauma life support care, effectiveness, hemostatic, hemorrhage, warfare.Abstract
Introduction: The use of new hemostatic agents to control hemorrhage in military environments is growing.Objectives: To synthesize and analyze the available evidence about the effectiveness of the different hemostatic agents utilized in tactical environments that are transported by army fighters.
Development: A narrative review of articles published in English and Spanish, in Medline (PubMed), Cochrane and Web of Science, and magazines, protocols, books, and manuals in the field of emergency and battlefield emergencies, who analyzed the study phenomenon and met the inclusion and exclusion criteria. After searching and selecting the studies, 7 articles were included in the narrative synthesis. In the studies, the following hemostatic agents were used QuikClot®, HemCon®, Celox®, and ChitoGauze HemCon®, in most studies, hemostatic agents were more than 88 % effective in stopping, reducing, and controlling external hemorrhage in combat victims, especially in union areas, also decreasing morbidity and mortality. Only QuikClot® had negative side effects causing burns. The correct handling of hemostatic agents requires prior training, which avoids administration mistakes.
Conclusions: Hemostatic agents are effective for treating external hemorrhage in combat victims and increasing their survival. It is necessary to train professionals to avoid mistakes in their handling. Future studies should investigate which of these agents is more effective.
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References
1. Grañas Campillo A, Tome Rodríguez I, Meneses Monroy A, González Cervantes S, Velarde García J. Uso del ácido tranexámico en hemorragias en zona de combate. Rev Rol Enfermería. 2018 [acceso: 02/11/2020];41(2):122-5. Disponible en: https://www.researchgate.net/profile/Juan_Velarde_Garcia/publication/32344-5079_Use_of_tranexamic_acid_in_hemorrhages_in_combat_zone/links/5a9643-baaca2721405695bfc/Use-of-tranexamic-acid-in-hemorrhages-in-combat-zone.pdf
2. Navarro RS, Pérez AF, Jiménez JV. Control of bleeding in the military environment. Revista Española de Anestesiología y Reanimación; 2012 [acceso: 02/11/2020]. 59(10): 562-72. Disponible en: https://doi.org/10.1016/j.redar.2012.06.010
3. Butler FK. Two decades of saving lives on the battlefield: tactical combat casualty care turns 20. Mil Med. 2017 [acceso: 02/11/2020];182(3-4): e1563- e1568. Disponible en: https://doi.org/10.7205/MILMED-D-16-00214
4. American Heart Association. Advanced Cardiovascular Life Support (ACLS) Provider Manual. Dallas, TX: American Heart Association; 2016.
5. Eastridge BJ, Mabry RL, Seguin P, Cantrell J, Tops T, Uribe P, et al. Death on the battlefield (2001-2011): implications for the future of combat casualty care. J Trauma Acute Care Surg. 2012 [acceso: 02/02/2021]; 73(6):S431-S437. Disponible en: https://doi.org/10.1097/TA.0b013e3182755dcc
6. Cruz Jaramillo M. Cartilla de TCCC 2016. Actualización guías de manejo TCCC. Chile: División de instrucción y simulación médica, Academia Politécnica Naval; 2016.
7. Maughon JS. An inquiry into the nature of wounds resulting in killed in action in Vietnam. Mil Med. 1970 [acceso: 02/11/2020];135(1): 8-13. Disponible en: https://pubmed.ncbi.nlm.nih.gov/4985194/
8. Butler FK, Holcomb JB, Giebner SD, McSwain NE, Bagian J. Tactical combat casualty care 2007: evolving concepts and battlefield experience. Mil Med. 2007 [acceso: 02/02/2021]; 172: 1-19. Disponible en: https://doi.org/10.7205/MILMED.172.Supplement_1.1
9. Zhang YJ, Gao B, Liu XW. Topical and effective hemostatic medicines in the battlefield. Int J Clin Exp Med. 2015 [acceso: 02/11/2020]; 8(1):10-9. Disponible en: https://pubmed.ncbi.nlm.nih.gov/25784969/
10. González Alonso V, Cuadra Madrid ME, Usero Pérez MC, Colmenar Jarillo G, Sánchez Gil MA. Control de la hemorragia externa en combate. Prehospital Emerg Care. 2009 [acceso: 02/11/2020]; 02(4): 293-304. Disponible en: https://www.elsevier.es/es-revista-prehospital-emergency-care-edicion-espanola--44-articulo-control-hemorragia-externa-combate-X1888402409460652
11. Navarro Suay R, Povo Castilla J, Hernández Abadía de Barbará A, Sáenz Casco L, Álvarez Herranz P. Use of blood components, medications and procedures for the hemorrhage treatment in the military environment. Sanid Mil. 2013 [acceso: 02/11/2020]; 69(2): 87-94. Disponible en: https://dx.doi.org/10.4321/S1887-85712013000200005
12. Littlejohn L, Bennett BL, Drew B. Application of current hemorrhage control techniques for backcountry care: part two, hemostatic dressings and other adjuncts. Wilderness and Environmental Medicine. 2015 [acceso: 02/11/2020]; 26(2):246-54. Disponible en: https://doi.org/10.1093/milmed/161.suppl_1.3
13. Monsieurs KG, Nolan JP, Bossaert LL, Greif R, Maconochie IK, Nikolaou NI, et al. European resuscitation council guidelines for resuscitation 2015: section 1. Executive summary. Resuscitation. 2015 [acceso: 02/11/2020]; 95:1-80. Disponible en: https://doi.org/10.1016/j.resuscitation.2015.07.038
14. Merchant RM, Topjian AA, Panchal AR, Cheng A, Aziz K, Berg KM, et al. Adult Basic and Advanced Life Support, Pediatric Basic and Advanced Life Support, Neonatal Life Support, Resuscitation Education Science, and Systems of Care Writing Groups. Part 1: Executive summary: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020 [acceso: 01/02/2021]; 142:S337-S357. Disponible en: https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000918
15. Pellegrino JL, Charlton NP, Carlson JN, Flores GE, Goolsby CA, Hoover AV, et al. American Heart Association and American Red Cross focused update for first aid. Circulation. 2020 [acceso: 02/11/2020];142(17) : e287-e303. Disponible en: https://doi.org/10.1161/CIR.0000000000000900
16. Shina A, Lipsky AM, Nadler R, Levi M, Benov A, Ran Y, et al. Prehospital use of hemostatic dressings by the Israel Defense Forces Medical Corps: A case series of 122 patients. J Trauma Acute Care Surg. 2015 [acceso: 02/11/2020];79(4): S204-9. Disponible en: https://doi.org/10.1097/TA.0000000000000720
17. Rhee P, Brown C, Martin M, Salim A, Plurad D, Verde D, et al. QuikClot use in trauma for hemorrhage control: case series of 103 documented uses. J Trauma Inj Infect Crit Care. 2008 [acceso: 02/11/2020]; 64(49):1093-9. Disponible en: https://doi.org/10.1097/TA.0000000000000720
18. Wedmore I, McManus JG, Pusateri AE, Holcomb JB. A special report on the chitosan-based hemostatic dressing: experience in current combat operations. J Trauma Inj Infect Crit Care. 2006 [acceso: 02/11/2020]; 60(3):655-8. Disponible en: https://doi.org/10.1097/01.ta.0000199392.91772.44
19. Cox ED, Schreiber MA, McManus J, Wade CE, Holcomb JB. New hemostatic agents in the combat setting. Transfusion. 2009 [acceso: 02/11/2020]; 49: 248S-55. Disponible en: https://doi.org/10.1111/j.1537-2995.2008.01988.x
20. te Grotenhuis R, van Grunsven PM, Heutz WM, Tan EC. Prehospital use of hemostatic dressings in emergency medical services in the Netherlands: A prospective study of 66 cases. Injury. 2016 [acceso: 02/11/2020]; 47(5):1007-11. Disponible en: https://doi.org/10.1016/j.injury.2016.01.005
21. Brown MA, Daya MR, Worley JA. Experience with chitosan dressings in a civilian EMS system. J Emerg Med. 2009 [acceso: 02/11/2020]; 37(1):1-7. Disponible en: https://doi.org/10.1016/j.jemermed.2007.05.043
22. Hatamabadi HR, Zarchi FA, Kariman H, Dolatabadi AA, Tabatabaey A, Amini A. Celox-coated gauze for the treatment of civilian penetrating trauma: a randomized clinical trial. Trauma Mon. 2015 [acceso: 02/11/2020]; (1):42-6. Disponible en: https://pubmed.ncbi.nlm.nih.gov/25825701/
23. Alam HB, Uy GB, Miller D, Koustova E, Hancock T, Inocencio R, et al. Comparative analysis of hemostatic agents in a swine model of lethal groin injury. J Trauma. 2003 [acceso: 02/11/2020]; 54(6):1077-82. Disponible en: https://doi.org/10.1097/01.TA.0000068258.99048.70
24. Rall JM, Cox JM, Songer AG, Cestero RF, Ross JD. Comparison of novel hemostatic dressings with QuikClot combat gauze in a standardized swine model of uncontrolled hemorrhage. J Trauma Acute Care Surg. 2013 [acceso: 02/11/2020];75: S150-6. Disponible en: https://doi.org/10.1097/TA.0b013e318299d909
25. Leonard J, Zietlow J, Morris D, Berns K, Eyer S, Martinson K, et al. A multi-institutional study of hemostatic gauze and tourniquets in rural civilian trauma. Journal of Trauma and Acute Care Surgery. 2016 [acceso: 02/11/2020]; 81(3): 441-4. Disponible en: https://doi.org/10.1097/TA.0000000000001115
26. Maimir F. Asistencia inicial a la baja de combate. Madrid: Secretaría de defensa, Inspección general de sanidad de la defensa, Ministerio de Defensa; 2011.
2. Navarro RS, Pérez AF, Jiménez JV. Control of bleeding in the military environment. Revista Española de Anestesiología y Reanimación; 2012 [acceso: 02/11/2020]. 59(10): 562-72. Disponible en: https://doi.org/10.1016/j.redar.2012.06.010
3. Butler FK. Two decades of saving lives on the battlefield: tactical combat casualty care turns 20. Mil Med. 2017 [acceso: 02/11/2020];182(3-4): e1563- e1568. Disponible en: https://doi.org/10.7205/MILMED-D-16-00214
4. American Heart Association. Advanced Cardiovascular Life Support (ACLS) Provider Manual. Dallas, TX: American Heart Association; 2016.
5. Eastridge BJ, Mabry RL, Seguin P, Cantrell J, Tops T, Uribe P, et al. Death on the battlefield (2001-2011): implications for the future of combat casualty care. J Trauma Acute Care Surg. 2012 [acceso: 02/02/2021]; 73(6):S431-S437. Disponible en: https://doi.org/10.1097/TA.0b013e3182755dcc
6. Cruz Jaramillo M. Cartilla de TCCC 2016. Actualización guías de manejo TCCC. Chile: División de instrucción y simulación médica, Academia Politécnica Naval; 2016.
7. Maughon JS. An inquiry into the nature of wounds resulting in killed in action in Vietnam. Mil Med. 1970 [acceso: 02/11/2020];135(1): 8-13. Disponible en: https://pubmed.ncbi.nlm.nih.gov/4985194/
8. Butler FK, Holcomb JB, Giebner SD, McSwain NE, Bagian J. Tactical combat casualty care 2007: evolving concepts and battlefield experience. Mil Med. 2007 [acceso: 02/02/2021]; 172: 1-19. Disponible en: https://doi.org/10.7205/MILMED.172.Supplement_1.1
9. Zhang YJ, Gao B, Liu XW. Topical and effective hemostatic medicines in the battlefield. Int J Clin Exp Med. 2015 [acceso: 02/11/2020]; 8(1):10-9. Disponible en: https://pubmed.ncbi.nlm.nih.gov/25784969/
10. González Alonso V, Cuadra Madrid ME, Usero Pérez MC, Colmenar Jarillo G, Sánchez Gil MA. Control de la hemorragia externa en combate. Prehospital Emerg Care. 2009 [acceso: 02/11/2020]; 02(4): 293-304. Disponible en: https://www.elsevier.es/es-revista-prehospital-emergency-care-edicion-espanola--44-articulo-control-hemorragia-externa-combate-X1888402409460652
11. Navarro Suay R, Povo Castilla J, Hernández Abadía de Barbará A, Sáenz Casco L, Álvarez Herranz P. Use of blood components, medications and procedures for the hemorrhage treatment in the military environment. Sanid Mil. 2013 [acceso: 02/11/2020]; 69(2): 87-94. Disponible en: https://dx.doi.org/10.4321/S1887-85712013000200005
12. Littlejohn L, Bennett BL, Drew B. Application of current hemorrhage control techniques for backcountry care: part two, hemostatic dressings and other adjuncts. Wilderness and Environmental Medicine. 2015 [acceso: 02/11/2020]; 26(2):246-54. Disponible en: https://doi.org/10.1093/milmed/161.suppl_1.3
13. Monsieurs KG, Nolan JP, Bossaert LL, Greif R, Maconochie IK, Nikolaou NI, et al. European resuscitation council guidelines for resuscitation 2015: section 1. Executive summary. Resuscitation. 2015 [acceso: 02/11/2020]; 95:1-80. Disponible en: https://doi.org/10.1016/j.resuscitation.2015.07.038
14. Merchant RM, Topjian AA, Panchal AR, Cheng A, Aziz K, Berg KM, et al. Adult Basic and Advanced Life Support, Pediatric Basic and Advanced Life Support, Neonatal Life Support, Resuscitation Education Science, and Systems of Care Writing Groups. Part 1: Executive summary: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020 [acceso: 01/02/2021]; 142:S337-S357. Disponible en: https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000918
15. Pellegrino JL, Charlton NP, Carlson JN, Flores GE, Goolsby CA, Hoover AV, et al. American Heart Association and American Red Cross focused update for first aid. Circulation. 2020 [acceso: 02/11/2020];142(17) : e287-e303. Disponible en: https://doi.org/10.1161/CIR.0000000000000900
16. Shina A, Lipsky AM, Nadler R, Levi M, Benov A, Ran Y, et al. Prehospital use of hemostatic dressings by the Israel Defense Forces Medical Corps: A case series of 122 patients. J Trauma Acute Care Surg. 2015 [acceso: 02/11/2020];79(4): S204-9. Disponible en: https://doi.org/10.1097/TA.0000000000000720
17. Rhee P, Brown C, Martin M, Salim A, Plurad D, Verde D, et al. QuikClot use in trauma for hemorrhage control: case series of 103 documented uses. J Trauma Inj Infect Crit Care. 2008 [acceso: 02/11/2020]; 64(49):1093-9. Disponible en: https://doi.org/10.1097/TA.0000000000000720
18. Wedmore I, McManus JG, Pusateri AE, Holcomb JB. A special report on the chitosan-based hemostatic dressing: experience in current combat operations. J Trauma Inj Infect Crit Care. 2006 [acceso: 02/11/2020]; 60(3):655-8. Disponible en: https://doi.org/10.1097/01.ta.0000199392.91772.44
19. Cox ED, Schreiber MA, McManus J, Wade CE, Holcomb JB. New hemostatic agents in the combat setting. Transfusion. 2009 [acceso: 02/11/2020]; 49: 248S-55. Disponible en: https://doi.org/10.1111/j.1537-2995.2008.01988.x
20. te Grotenhuis R, van Grunsven PM, Heutz WM, Tan EC. Prehospital use of hemostatic dressings in emergency medical services in the Netherlands: A prospective study of 66 cases. Injury. 2016 [acceso: 02/11/2020]; 47(5):1007-11. Disponible en: https://doi.org/10.1016/j.injury.2016.01.005
21. Brown MA, Daya MR, Worley JA. Experience with chitosan dressings in a civilian EMS system. J Emerg Med. 2009 [acceso: 02/11/2020]; 37(1):1-7. Disponible en: https://doi.org/10.1016/j.jemermed.2007.05.043
22. Hatamabadi HR, Zarchi FA, Kariman H, Dolatabadi AA, Tabatabaey A, Amini A. Celox-coated gauze for the treatment of civilian penetrating trauma: a randomized clinical trial. Trauma Mon. 2015 [acceso: 02/11/2020]; (1):42-6. Disponible en: https://pubmed.ncbi.nlm.nih.gov/25825701/
23. Alam HB, Uy GB, Miller D, Koustova E, Hancock T, Inocencio R, et al. Comparative analysis of hemostatic agents in a swine model of lethal groin injury. J Trauma. 2003 [acceso: 02/11/2020]; 54(6):1077-82. Disponible en: https://doi.org/10.1097/01.TA.0000068258.99048.70
24. Rall JM, Cox JM, Songer AG, Cestero RF, Ross JD. Comparison of novel hemostatic dressings with QuikClot combat gauze in a standardized swine model of uncontrolled hemorrhage. J Trauma Acute Care Surg. 2013 [acceso: 02/11/2020];75: S150-6. Disponible en: https://doi.org/10.1097/TA.0b013e318299d909
25. Leonard J, Zietlow J, Morris D, Berns K, Eyer S, Martinson K, et al. A multi-institutional study of hemostatic gauze and tourniquets in rural civilian trauma. Journal of Trauma and Acute Care Surgery. 2016 [acceso: 02/11/2020]; 81(3): 441-4. Disponible en: https://doi.org/10.1097/TA.0000000000001115
26. Maimir F. Asistencia inicial a la baja de combate. Madrid: Secretaría de defensa, Inspección general de sanidad de la defensa, Ministerio de Defensa; 2011.
Published
2021-05-22
How to Cite
1.
Corrochano-Rodríguez L, Martín BR, Caro-Alonso P Ángel. Effectiveness of hemostatic agents to control external bleeding in military health. Rev Cubana Med Milit [Internet]. 2021 May 22 [cited 2025 May 13];50(2):e02101166. Available from: https://revmedmilitar.sld.cu/index.php/mil/article/view/1166
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