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ABSTRACT: Fabric-like hemostatic dressings offer promise for hemorrhage control in noncompressible areas, especially given their similarity in form to standard gauze currently in use. Recently, two such products, Combat Gauze (CBG) and TraumaStat (TMS), were introduced. Their performance is evaluated in two vascular injury models.
The dressings were evaluated in anesthetized Yorkshire pigs, hemorrhaged by full transection of the femoral vasculature with 2 min free bleeding period (CBG = 6, TMS = 6) or by 4 mm femoral arterial puncture with 45 s free bleeding period (CBG = 8, TMS = 8). After injury, dressings were applied, followed by 5 min of manual compression and then 500 mL resuscitation fluid infused over 30 min. Vital signs, blood pressure, and blood loss were recorded throughout the 3-h experiment. Bleeding control was the primary outcome.
All animals had similar pretreatment mean arterial pressure (MAP) (∼ 36.5 mmHg); pretreatment blood loss following injury was similar for both dressing groups in the two models [24% ± 8% estimated blood volume (EBV) 2 min after transection and 17% ± 4% EBV 45 s after puncture. Incidence of post-treatment bleeding, primarily occurring after release of manual compression or restoration of blood pressure, was more frequent in the puncture model (17% with both CBG and TMS) than the transection model (57% with CBG versus 75% with TMS). Post-treatment blood loss not controlled by the dressing was 19% ± 22% and 31% ± 17% EBV, for CBG and TMS, respectively. Survival rate was 100% for both dressings in the transection model, and was 88% for CBG and 50% for TMS in the puncture model.
These findings indicated that CBG and TMS were similarly effective in improving hemostasis. These two fabric-like dressings showed easy application and removal, leaving a clean wound for surgical repair.
Journal of Surgical Research 07/2011; 169(1):92-8. · 2.25 Impact Factor
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ABSTRACT: U.S. military troops deploying to war zones are currently administered the Automated Neuropsychological Assessment Metrics (ANAM4) Traumatic Brain Injury (TBI) Battery to establish individual neurocognitive performance baselines. In part, the utility of the ANAM4 TBI Battery baseline measurement depends on test-retest reliability of this instrument. The purpose of this report was to evaluate performance following multiple administrations of the ANAM4 TBI Battery: does performance in a repeated measures paradigm constitute a stable, interpretable indication of baseline neurocognitive ability?
The data presented here are from the ANAM4 TBI Battery administered four times to a group of U.S. Marines in Study 1 and eight times to a group of New Zealand Defence Force personnel in Study 2.
The results show practice effect in five of six performance subtests in both Study 1 and Study 2.
Results are consistent with expectations that multiple test sessions are required to reach stable performance on some computerized tasks. These results have implications for taking ANAM4 TBI Battery practice effects into account in test administration and in data interpretation.
Aviation Space and Environmental Medicine 01/2011; 82(1):34-9. · 0.88 Impact Factor
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Françoise Arnaud,
Dione Parreño-Sadalan,
Toshiki Tomori,
Mariam Grace Delima,
Kohsuke Teranishi, Walter Carr,
George McNamee,
Anne McKeague,
Krishnanurthy Govindaraj,
Charles Beadling,
Clifford Lutz,
Trueman Sharp,
Steven Mog,
David Burris,
Richard McCarron
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ABSTRACT: Major improvements have been made in the development of novel dressings with hemostatic properties to control heavy bleeding in noncompressible areas. To test the relative efficacy of different formulations in bleeding control, recently manufactured products need to be compared using a severe injury model.
Ten hemostatic dressings and the standard gauze bandage were tested in anesthetized Yorkshire pigs hemorrhaged by full transection of the femoral vasculature at the level of the groin. Application of these dressings with a 5-minute compression period (at approximately 200 mm Hg) was followed with a subsequent infusion of colloid for a period of 30 minutes. Primary outcomes were survival and amount and incidence of bleeding after dressing application. Vital signs and wound temperature were continuously recorded throughout the 3-hour experimental observation.
These findings indicated that four dressings were effective in improving bleeding control and superior to the standard gauze bandage. This also correlated with increased survival rates. Absorbent property, flexibility, and the hemostatic agent itself were identified as the critical factors in controlling bleeding on a noncompressible transected vascular and tissue injury.
Celox, QuikClot ACS, WoundStat, and X-Sponge ranked superior in terms of low incidence of rebleeding, volume of blood loss, maintenance of mean arterial pressure >40 mm Hg, and survival.
The Journal of trauma 10/2009; 67(4):848-55. · 2.48 Impact Factor
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ABSTRACT: The use of mineral (clay) or biologic (chitosan) materials has improved the efficacy of dressings used in the bleeding control of noncompressible areas. A series of novel manufactured products already evaluated in a vascular transection model was further compared in a severe vascular puncture injury model.
Ten hemostatic dressings were tested in anesthetized Yorkshire swine hemorrhaged for 45 seconds in a femoral arterial puncture model. Application of these dressings was followed by 5 minutes of compression (about 175 mm Hg), and at 15 minutes, 500 mL resuscitation fluid (Hextand) was infused during a 30-minute period. The animals were monitored for a 3-hour experimental observation period. Primary outcomes were incidence of bleeding after dressing application and animal survival.
Blood loss was 18.8% +/- 5.2% estimated blood volume (EBV) after 45 seconds of free bleeding. Relative performance of dressings is characterized as groups of dressings that performed similarly. Recurrence of bleeding after application was observed with most dressings and was lower with Woundstat, Celox, X-Sponge, and ACS+ (35% +/- 49%) compared with FP-21, Hemcon, Chitoflex, and Bloodstop (79% +/- 43%; P < .01). Blood loss after treatment was 25.3% +/- 18.4% EBV for the top four dressings and 53.0% +/- 18.4% EBV for the bottom four (P < .05). Survival was higher for top four vs bottom four dressings (78% +/- 12% vs 25% +/- 0%, respectively; P < .01). Overall performance of these dressings according to survival, incidence of bleeding, and post-treatment blood loss, yielded similar ranking as with a previously tested transection injury model.
The findings indicated that the efficacy of Woundstat, Celox, X-Sponge, and ACS+ were similar and superior in improving survival, hemostasis, and maintenance of mean arterial pressure in an actively bleeding wound caused in this severe vascular injury model.
Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 09/2009; 50(3):632-9, 639.e1. · 3.52 Impact Factor
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ABSTRACT: Zeolites have hemostatic properties used to stop bleeding in severe hemorrhage. Manufactured QuikClot is an approved zeolite-based hemostatic agent for battlefield use. The exothermic reaction associated with QuikClot as loose granules or as granules packaged in a mesh bag has potential burn effects; this led to the development of a formulation of "cooler" non-exothermic QuikClot. The goal of this study was to compare the elevation of temperature of these formulations upon contact with blood.
Following full transection of the femoral vasculature, anesthetized Yorkshire pigs (n = 15) (28.8 +/- 1.5 kg) were hemorrhaged for 2 min and treated with 100 g of bagged QuikClot (Advanced Clotting Sponge (ACS) (n = 4)) or a modified non-exothermic formulation (ACS+ (n = 11)). Vital signs and temperature at the dressing/tissue interface were continuously recorded for 3 h. Additional procedures were used to examine effects of different ratios of blood to zeolite on temperature elevation.
Total post-treatment blood loss was comparable for ACS+_E and ACS_E groups (overall average: 18.6 +/- 10.5% EBV). Temperature recorded at the dressing/tissue interface was significantly lower with ACS+ vs. ACS (40.3 +/- 1.8 vs. 61.4 +/- 10.7 degrees C, respectively, p < 0.01) and was 3.2 +/- 2.6 degrees C higher than rectal temperature (38.0 +/- 0.7 degrees C, p < 0.01). Survival at endpoint (7/11 vs. 4/4) and average survival time (134 +/- 64 vs. 180 min) were greater for both ACS+ and ACS in comparison to Standard Dressing. The wound temperature with ACS was reduced with greater blood to product ratios and this pattern was paralleled with in vitro measurements.
The lower heat release with ACS+ compared to ACS was confirmed in an animal model and ACS+ had similar efficacy in arresting bleeding when compared to Standard Dressing.
Annals of biomedical engineering 10/2008; 36(10):1708-13. · 2.41 Impact Factor
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Aviation Space and Environmental Medicine 09/2003; 74(8):902-3. · 0.88 Impact Factor
