HEMCON for QUICK CLOT?

[kj_gully]

Just read in the journal of special operations medicine, reprinted from journal of trauma:injury, infection & care, october 2005-
in trial of fatal exsanguinating femoral wounds in swine, Quikclot, Chitosan (hemcon) and fibrin dressing ( heard of but not seen by me) were tested under identical conditions. standard control was army (US) Field Bandage. after 45 seconds of bleed, each hemostatic agent was applied twice, for 3 min/time,through blood pool. Results: AFB: 0 hemostasis, Quikclot: 0 hemostasis, marked wound temp increase (71 degrees C) Chitosan: Briefly stopped bleeding in 1 animal. 0 surviviors. fibrin Dressing: 10 of 15 animals acheived hemostasis. their conclusions: quikclot in this trial didn't perform function, and heated tissue to a point where it showed 'gross and histological change of unknown clinical significance" Chitosan extended bleed out times, by a non significant degree. Fibrin prevented exsanguination 2/3 time, and significantly extended bleed out times for the rest.

 

[JANES]

Can you clarify the part of your post that says the HemCon heated the tissue?  HemCon doesnt get hot.  The Fibrin dressing used to cost $1000 per dressing.  I say used because they have all been recalled because they contain human fibrin and the liability was too much and they couldnt field the dressing. 

The test is also not realistic.  Each product has to be used specifically, not generally.  Each need training to use, and specific training for each dressing.  If used properly, I'm sure the mortality rates would be affected.  I would also throw out the fact that HemCon may not have sorted out their quality control issue to which now they say they have.

We're going to see a lot of new testing going on with the Quick Clot ACS, the HemCon ChitoFlex and the Celox all out.

 

[kj_gully]

ya ya, thanx for the pick up, will edit.

 

[kj_gully]

don't disagree with anything you've rebutted, just putting it out there. To me this test was a test of the lowest common denominator, ie untrained person applying product. obviously if TK's were used, blood mopped up products could work better. I've seen a promo video from Hemcon on a swine femoral bleed pretty impressive. I would be glad to have any of them in my bag of tricks. price being no object, which of course it is, these fibrin dressings seem to be hands down a better product for this particular scenario.

 

[JANES]

The lowest common denominator should not be a factor with these devices.  Training is the key to their use.  If you are carrying it and not trianed to use it properly, you may as well of saved your money and stuck with the old field dressing.  It s the same with any peice of equipment you carry, you need to be trained how to use it. 

I'm not arguing with you, I'm just saying that lowest common denominator tests shouldnt happen, becasue they dont find any quantifiable conclusions.

I could test weapons by taking a 4 different rifles and shooting them at a target, but if I am not aiming and using proper marksmanship principles, and I say that the rifles that didnt hit the target very well are no good, its not a realiable test.

The fibrin dressings may be the magic bullet.  Thats becasue they are full of human fibrin.  The bottom line still remains - they are not and will most likely never be available.  Liability way too high with human products in them, and even IF they were available, at $1000 a peice, who is going to buy it?

Its the same with the Factor VIIa that people are all excited about.  At $10,000 a pop and a storage temp requirment of 10 degrees, it wont be fielded any time soon.

 

[tomahawk6]

Some recent HEMCON articles.

http://www.strategypage.com/htmw/htmoral/articles/20060624.aspx

Powerpoint:
http://www.cs.amedd.army.mil/clsp/slides/CHITOSAN%20HEMOSTATIC%20DRESSING.ppt

http://www.sciencentral.com/articles/view.php3?type=article&article_id=218392341

Also a great pdf article.
www.nomi.med.navy.mil/SWMI/ATF Resource/1.17TCCC.pdf

 

[Sawbones]

Its the same with the Factor VIIa that people are all excited about.  At $10,000 a pop and a storage temp requirement of 10 degrees, it wont be fielded any time soon.

Seems to be some confusion re: Factor rVIIa being in the CF - it has been 'fielded' with the CF in Op Athena and Op Archer since 2004.  Anywhere we deploy blood products, we'll deploy Factor rVIIa.  Hasn't been needed much yet, thankfully.  The Lab techs keep it in the fridge for the OR team.

Sawbones.

 

[Armymedic]

it has been 'fielded' with the CF in Op Athena and Op Archer since 2004.  Anywhere we deploy blood products, we'll deploy Factor rVIIa.  Hasn't been needed much yet, thankfully.  The Lab techs keep it in the fridge for the OR team.

Welcome to the site, Sawbones. (Orthopedic surgeon, perchance?)

Well that is good news.
But that helps the medics treating the troops whom are bleeding at the battle edge who still have a transport time of over 1 hour in what way?

 

[JANES]

Seems to be some confusion re: Factor rVIIa being in the CF - it has been 'fielded' with the CF in Op Athena and Op Archer since 2004.  Anywhere we deploy blood products, we'll deploy Factor rVIIa.  Hasn't been needed much yet, thankfully.  The Lab techs keep it in the fridge for the OR team.

Sawbones.

I'll just clarify.  What I meant by fielded was in the medics pack to be infused in the "field".  I've never considered a MTF the field even if it is in Kabul or KAF etc.  What most doctors and a nurses considers the field is a little different than my perspective of the field I guess.  Just my perspective.  And my whole point - it's in the fridge!

 

[Sawbones]

Army Medic - can't help you too much with the profile - my trade is too small  

Factor rVIIa won't help the MedTech avoid having his patient become a KIA, but does help prevent his casualty becoming a DOW after entering the facility.  Thats a good thing.

Most KIAs occur far too quickly for Factor rVIIa to be useful - it only corrects disordered coagulation, which takes time to set up, usually after a bunch of IV fluid and blood products.

With current technology, even with the principles of TCCC, especially control of visible hemorrhage, the most useful tool for the MedTech in dealing with trunk wounds far from Mother is still the helicopter.  That hasn't changed in our lifetimes.  

Hence some of the the recent comments in the media by commanders about wanting our own helos.  Can't imagine what it would be like watching someone bleed out while they're trying to find a helo, but it still happens. Someone has told me that nationality is now part of the nine-line, that says something about it.

Bleeding within the wounded torso currently has no remedy with the exception of timely surgery. That's one of the reasons the KIA rate hasn't changed too much in the last 150 years (head wounds is another).  

We're still looking for the invention to change that, but so far our best friend in this area has been better body armour.

The MedTech has to ensure the casualty doesn't become a KIA from stuff he/she could fix - visible hemorrhage, pneumothorax, airway obstruction, hypothermia, over-resuscitation, wasting time or just missing the injury.  He/she also prevents DOWs by preventing complications due to delay, poor splints, poor dressings etc.

For those torso wounds, a key skill is knowing what is the fastest way to get the casualty back to a surgical unit at any given point in the mission.  Overall, its a much different situation than that with which the civilian EMS guys have to contend.

Sawbones

 

[tomahawk6]

The survival rate in theater is at 90% which is really amazing. The reasons are better point of injury care and technology. The casualty rate in theater is 17500 wounded and 2500 KIA. As in Vietnam the role of the helicopter is instrumental in the survival rate of wounded soldiers.

http://www.defenselink.mil/news/Mar2005/20050307_105.html

http://www.americanprowler.org/dsp_article.asp?art_id=9573