Progress in Management of Bleeding in Battlefield

choi

My comment: I was excited upon reading the report: in trauma--in civvy street or war zone--hemorrhage before medical assistance arrives is a major cause of death. So, how to stanch it is critical. The report proves to be false on HenCon and WoundStat, however--and ambiguous about circumstances where an abdominal belt can help. I contemplated whether to bring the report to your attention, and conclude I should--to keep you up to date and as an object lesson.



Making The Gut Shot Much Less Fatal. Strategy Page, Aug 27, 2013.
http://strategypage.com/htmw/htatrit/articles/20130827.aspx

Note:
(a) aortic occlusion
(i) The Strategy Page report actually talks about this:

The Abdominal Aortic Tourniquet - AAT.™  Speer Operational Technologies, undated
http://www.speeroptech.com/aat/index.html

Quote:

“the first device to provide stable and complete occlusion of flow of blood to the lower extremities * * * for difficult to control inguinal hemorrhage

“The project is focused at the number one priority identified by the Institute of Surgical Research for care on the battlefield: how to address uncompressible hemorrhage that is not treatable by a tourniquet in the leg, groin and [especially] inguinal region.

“The AAT™ provides a rapid application of pneumatic compression to the aorta at the abdominal-pelvic junction to occlude blood flow in the inguinal arteries.

“The AAT™ is a circumferential device that greatly increases the stability of the compression. The pneumatic wedge shaped bladder provides focused pressure to squeeze the blood vessels passing through the lower abdomen and preventing flow.

The problem with this device of Speer’s is it can not help with abdominal bleeding--whether from blood vessels (including aorta 主動脈) or internal organs (from blunt trauma, for example)--above the lower abdomen (high than the aortic bifurcation to become two femoral arteries 股動脈).
(ii) In the battlefield, first aid is administered by a medic--not a doctor, nurse or paramedic. Ideally--the administrator may need sterilization and possibly X-ray to guide the catheter--a catheter can do a better job to stop hemorrhage from upper abdominal source.
(A) Fogarty® Occlusion Catheters; Temporary peripheral and aortic intraluminal occlusion. Edwards Lifesciences, undated.
http://ht.edwards.com/scin/edwar ... surgery/ar06299.pdf
(B) Matsuoka S et al, Temporary percutaneous aortic balloon occlusion to enhance fluid resuscitation prior to definitive embolization of posttraumatic liver hemorrhage. Cardiovasc Intervent Radiol, 24: 274:-276 (2001)
http://link.springer.com/article ... 0-001-0003-0#page-1
(abstrct; hepatic arterial 肝動脈 bleeding from traumatic liver injury)

And aortic occlusion can not last too long (a case report said it used aortic occlusion for 40 minutes); otherwise the lower body would lack oxygen.

(b) "Chitosan Hemostatic Dressing (more commonly called HemCon)"
(i) Chitosan
http://en.wikipedia.org/wiki/Chitosan
(made by treating shrimp and other crustacean shells with the alkali sodium hydroxide; section 5 Biomedical uses)

The first sentence of the Wiki page states, "Chitosan is a linear polysaccharide composed of randomly distributed β-(1-4)-linked D-glucosamine [] and N-acetyl-D-glucosamine."

Basically it says chitosan is made up of
(A) glucosamine, which is a glucose in which an hydroxyl group (OH) is replaced by an amino group (NH2),
and
(B) N-acetyl-glucosamine, which is a glucosamine where a hydrogen atom in the amino group of glucosamine was substituted by an acetyl group (CH3CO-, which is a molecule of acetic acid WITHOUT the hydroxy group).
N-Acetylglucosamineh
ttp://en.wikipedia.org/wiki/N-Acetylglucosamine

(ii) Chitosan is made by treating shrimp shell--ie, Chitin--with NaOH. That is what (i) describes.

Chitin
http://en.wikipedia.org/wiki/Chitin
(is a long-chain polymer of a N-acetylglucosamine, a derivative of glucose; Chitosan is prepared from chitin by deacetylation)
(iii) Chitin (n; French chitine, from Greek chitōn; First Known Use  circa 1839)
http://www.merriam-webster.com/dictionary/chitin
(iv) chiton (costume)
http://en.wikipedia.org/wiki/Chiton_(costume)

was Greek garment worn by men and women alike.

Because the preceding three words have Greek root, the "ch" in them are pronounced "k"--ditto “chaos.”
(v) Products. HemCon Medical Technologies, Inc, undated
http://hemcon.com/Products.aspx
(A) Click "HemCon Patch® PRO" and in the new Web page, there is a tab "How It Works"
(B) A sister product is Chitoflex, which was mentioned in swine tests below.
(C) In the homepage of Hemcon.com is a prominent announcement that it has successfully emerged from Chapter 11 bankruptcy filing on May 26, 2013, under new ownership. It is a bad sign: if their products are so good and sells like hot cake * * *
(vi) hemostasis (n; New Latin, from Greek haimostasis: haimo- hem- [or hemo- blood] + -stasis [stoppage]; First Known Use: 1843):
"arrest of bleeding"
http://www.merriam-webster.com/dictionary/hemostasis

(c) WoundStat
(i) Jeffrey Kelley, VCU Develops 'WoundStat;' Independent study by Army found product for troops' blood loss to be highly effective. Richmond Times-Dispatch, May 29, 2007.
http://www.research.vcu.edu/ott/ ... 20RTD%20Article.pdf
(Kevin Ward of Virginia Commonwealth University developed “a tan-colored concoction of minerals that looks like a cross between flour, sand and cat litter. After its use, WoundStat can be peeled off the injury” and then set up a startup TraumaCure to manufacture and commercial the product)
(ii) Kheirabadi BS et al, Combat Gauze and WoundStat: New Choices of Hemostatic Treatment for Combat Wounds. United States Army Institute of Surgical Research, Fort Sam Houston, Texas, 2008.
http://www.z-medica.com/ZMedica/ ... and-WoundStat_1.pdf
("WoundStat[:] A non-metallic clay mineral (Smectite) that swells when exposed to water/blood and forms clay material with high plasticity and strong tissue adhesiveness")
(A) The report was published as

Kheirabadi BS et al, Comparison of New Hemostatic Granules/Powders With Currently Deployed Hemostatic Products in a Lethal Model of Extremity Arterial Hemorrhage in Swine. J Trauma, 66:316-326
http://www.ncbi.nlm.nih.gov/pubmed/19204503
(followed by discussion at 327-328)

conclusion: “The new hemostatic agents are significantly more effective in treating arterial hemorrhage than currently deployed products. Among them, WS [WoundStat] granules appear to be most efficacious, followed by SQR [super quick relief] and CX [Celox] powders
(B) Based on the study, the Army bought and dispatched it to the frontlines.
(iii) Virginia Commonwealth University
http://en.wikipedia.org/wiki/Virginia_Commonwealth_University
(located in Richmond, Virginia; founded in 1838)
(iv) But WoundStat could not pass the muster in clinical trials at battlefields (on soldiers).

Gina Cavallaro, WoundStat Found to Be Potentially Hazardous. Army Times, Apr 21, 2009.
http://www.armytimes.com/article ... tentially-hazardous

You will have to Google the title and read the cached version, because the newspaper placed the report behind the pay wall.
(vi) as far as I can tell, the company TraumaCure is defunct and WoundStat is no more.

(d) QuikClot® Combat Gauze.™ Z-Medica, undated
http://www.z-medica.com/healthca ... t-Combat-Gauze.aspx
(is a soft, white, sterile, nonwoven 3” by 4 yds rolled gauze impregnated with kaolin, an inert mineral that does not contain animal or human proteins or botanicals”)

For kaolin,see Kaolinite
http://en.wikipedia.org/wiki/Kaolinite
(a clay mineral; The name is derived from Chinese Kao-Ling 高岭; can be used “as adsorbents in water and wastewater treatment”)

Quote: “In April 2008, the US Naval Medical Research Institute announced the successful use of a kaolinite-derived aluminosilicate nanoparticle infusion in traditional gauze, known commercially as QuikClot Combat Gauze

(e) Then came a blow on the fancy products, which may not be better than ordinary gauze.

Littlejohn LF et al, 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 Medicine, 18: 340-350 (2011)
http://www.ncbi.nlm.nih.gov/pubmed/21496135
(Result: “SG [standard gauze] dressing performed similarly to the hemostatic agents tested [including Combat Gauze]. This supports the concept that proper wound packing and pressure may be more important than the use of a hemostatic agent in small penetrating wounds with severe vascular trauma”)