An alternative hemostatic dressing: Comparison of CELOX, HemCon, and QuikClot

Department of Emergency Medicine, Naval Medical Center, Portsmouth, VA, USA.
Academic Emergency Medicine (Impact Factor: 2.01). 02/2008; 15(1):74-81. DOI: 10.1111/j.1553-2712.2007.00009.x
Source: PubMed

ABSTRACT Uncontrolled hemorrhage remains a leading cause of traumatic death. Several topical adjunct agents have been shown to be effective in controlling hemorrhage, and two, chitosan wafer dressing (HemCon [HC]) and zeolite powder dressing (QuikClot [QC]), are being utilized regularly on the battlefield. However, recent literature reviews have concluded that no ideal topical agent exists. The authors compared a new chitosan granule dressing (CELOX [CX]) to HC, QC and standard dressing in a lethal hemorrhagic groin injury.
A complex groin injury with transection of the femoral vessels and 3 minutes of uncontrolled hemorrhage was created in 48 swine. The animals were then randomized to four treatment groups (12 animals 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 compression dressing. Hetastarch (500 mL) was infused over 30 minutes. Hemodynamic parameters were recorded over 180 minutes. Primary endpoints included rebleed and death.
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). Survival for HC (67%) (95% CI = 53.7% to 80.3%) and QC (92%; 95% CI = 84.3% to 99.7%) did not differ from SD.
In this porcine model of uncontrolled hemorrhage, CX improved hemorrhage control and survival. CELOX is a viable alternative for the treatment of severe hemorrhage.

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Available from: Buddy Kozen, Jan 21, 2014
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    • "Of the commercially available hemostats, the HemCon® chitosan (CS) bandage (HemCon Medical Technologies, Inc., Portland, OR, USA) and QuikClot® zeolite powder (Z-Medica Corp, Wallingford, CT, USA) are reportedly the most effective for reducing or stopping bleeding. The former comprises a lyophilized CS derivate, with positively charged amine groups, which accelerate blood clot formation by attracting negatively charged molecules or proteins on red blood cell (RBC) membranes or in plasma (eg, fibrinogen).3,4 The latter absorbs water released from injured sites and can increase local platelet concentrations and coagulation factors.5,6 "
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    ABSTRACT: Chitosan nanoparticles (NPs) decorated with adenosine diphosphate (ADP) (ANPs) or fibrinogen (FNPs) were used to fabricate hemostatic NPs that can shorten blood clotting time and prevent severe local hemorrhage. The structure and mechanical properties of the blood clot induced with ANP (clot/ANP) or FNP (clot/FNP) were also investigated. The NPs, ANPs, and FNPs, which had particle sizes of 245.1±14.0, 251.0±9.8, and 326.5±14.5 nm and zeta potentials of 24.1±0.5, 20.6±1.9, and 15.3±1.5 mV (n=4), respectively, were fabricated by ionic gelation and then decorated with ADP and fibrinogen. The zeta potentials and Fourier transform infrared (FTIR) spectroscopy of the NPs confirmed that their surfaces were successfully coated with ADP and fibrinogen. The scanning electron microscope (SEM) micrographs of the structure of the clot induced with "undecorated" chitosan NPs (clot/NP), clot/ANP, and clot/FNP (at 0.05 wt%) were different, after citrated bloods had been recalcified by a calcium chloride solution containing NPs, ANPs, or FNPs. This indicated that many NPs adhered on the membrane surfaces of red blood cells, that ANPs induced many platelet aggregates, and that FNPs were incorporated into the fibrin network in the clots. Measurements of the blood clotting times (Tc) of blood clot/NPs, clot/ANPs, and clot/FNPs, based on 90% of ultimate frequency shifts measured on a quartz crystal microbalance (QCM), were significantly (P<0.05) (n=4) shorter than that of a clot induced by a phosphate-buffered solution (PBS) (clot/PBS) (63.6%±3.1%, 48.3%±6.2%, and 63.2%±4.7%, respectively). The ΔF2 values in the spectra of frequency shifts associated with the propagation of fibrin networks in the clot/ANPs and clot/FNPs were significantly lower than those of clot/PBS. Interestingly, texture profile analysis of the compressional properties showed significantly lower hardness and compressibility in clot/NPs and clot/ANPs (P<0.05 or better) (n=4) compared with clot/PBS and clot/FNPs. Accordingly, among the hemostatic NPs, ANP substantially reduced blood clotting times, ΔF2 values, and compression flow properties of the clot. Hence, ANPs have potential applications for preventing severe local hemorrhage.
    International Journal of Nanomedicine 03/2014; 9(1):1655-64. DOI:10.2147/IJN.S57855 · 4.38 Impact Factor
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    • "Chitosan was reported to improve homeostasis (Kozen et al. 2008) and promote granulation by enhancing the function of inflammatory cells such as leukocytes, fibroblasts and macrophages (Ueno et al. 2001). Furthermore, chitosan has antimicrobial effects against bacteria, fungi and viruses (Rabea et al. 2003). "
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    SpringerPlus 12/2013; 2(1):79. DOI:10.1186/2193-1801-2-79
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    • "Because of their antibacterial capability, chitin-based materials are fabricated into bandages [107]. These bandages are now regularly utilized from the bedsides to the battlefield, and are available both commercially and industrially [108]. Currently, similar products are being tested in clinical trials of wound debridement, chronic ulcers, and dental dressings. "
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    ABSTRACT: Chitin-based materials and their derivatives are receiving increased attention in tissue engineering because of their unique and appealing biological properties. In this review, we summarize the biomedical potential of chitin-based materials, specifically focusing on chitosan, in tissue engineering approaches for epithelial and soft tissues. Both types of tissues play an important role in supporting anatomical structures and physiological functions. Because of the attractive features of chitin-based materials, many characteristics beneficial to tissue regeneration including the preservation of cellular phenotype, binding and enhancement of bioactive factors, control of gene expression, and synthesis and deposition of tissue-specific extracellular matrix are well-regulated by chitin-based scaffolds. These scaffolds can be used in repairing body surface linings, reconstructing tissue structures, regenerating connective tissue, and supporting nerve and vascular growth and connection. The novel use of these scaffolds in promoting the regeneration of various tissues originating from the epithelium and soft tissue demonstrates that these chitin-based materials have versatile properties and functionality and serve as promising substrates for a great number of future applications.
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