New Agents Found to Help Control External Bleeding

CORONADO, CALIF. — Two novel technologies are helping to control external bleeding when conventional methods such as direct pressure and gauze dressings fail.

These include products that contain chitosan or zeolite, Dr. Brant A. Putnam said at a meeting sponsored by the American College of Emergency Physicians.

Chitosan is a biodegradable, nontoxic carbohydrate derived from chitin, a naturally occurring substance. "It has a muco-adhesive property that binds everything together," said Dr. Putnam, chief of trauma and surgical care at Harbor-UCLA Medical Center in Torrance, Calif. "It probably activates platelets, and it may vasoconstrict locally. Then there are interactions with the red blood cell surface that we don't quite understand, so I'm sure there will be more research to follow."

Several animal studies have demonstrated its effectiveness as a hemostatic agent. In a human study published online Nov. 19, 2007, in the Journal of Emergency Medicine, paramedics used a hemostatic dressing made of chitosan (HemCon Bandage) in 34 wounds they couldn't control with direct pressure (doi:10.1016/j.jemermed.2007.05.043

The bandage, which was approved by the Food and Drug Administration in 2003 and requires users to cut it to the proper shape prior to application, controlled bleeding in 25 of the cases (74%) within 3 minutes. User error was a factor in six of the seven failures.

"You have to make sure that you put the right side down on the wound in order for the hemostasis to occur," Dr. Putnam explained.

The other technology proving effective for external hemostasis includes products that contain zeolite, a derivative of volcanic rock. When applied to gauze and placed on wounds, zeolite works as a molecular sieve and captures all the water locally, creating an exothermic reaction, said Dr. Putnam, who is also associate director of the Harbor-UCLA Medical Center general surgery residency program.

"We think that it dehydrates the wound of all the water properties, leaving a high concentration of all the clot-promoting components: the coagulation factors, the proteins, the cells," he explained.

The zeolite-based product QuikClot (Z-Medica Corp.), developed in 2002, is currently approved for external use only. But Dr. Putnam and his associates have used it on rare occasions to help pack life-threatening bleeding from internal wounds such as those caused by high-velocity gunfire. "I don't recommend that—I'm just saying that when we were faced with the life or death choice, we used it as part of packing internally, and the patients did very well," he said.

A recent survey of QuikClot's use in 69 cases by the U.S. military in Iraq, in 20 cases by civilian trauma surgeons, and in 14 cases by civilian first responders demonstrated an overall efficacy of 92% (J. Trauma 2008;64:1093–9). The researchers speculated that the QuikClot failures were due to the coagulopathic state of a patient from massive resuscitation or the inability to get the product directly to the source of bleeding.

Dr. Putnam said that he had no relevant disclosures to make.

CORONADO, CALIF. — Two novel technologies are helping to control external bleeding when conventional methods such as direct pressure and gauze dressings fail.

These include products that contain chitosan or zeolite, Dr. Brant A. Putnam said at a meeting sponsored by the American College of Emergency Physicians.

Chitosan is a biodegradable, nontoxic carbohydrate derived from chitin, a naturally occurring substance. "It has a muco-adhesive property that binds everything together," said Dr. Putnam, chief of trauma and surgical care at Harbor-UCLA Medical Center in Torrance, Calif. "It probably activates platelets, and it may vasoconstrict locally. Then there are interactions with the red blood cell surface that we don't quite understand, so I'm sure there will be more research to follow."

Several animal studies have demonstrated its effectiveness as a hemostatic agent. In a human study published online Nov. 19, 2007, in the Journal of Emergency Medicine, paramedics used a hemostatic dressing made of chitosan (HemCon Bandage) in 34 wounds they couldn't control with direct pressure (doi:10.1016/j.jemermed.2007.05.043

The bandage, which was approved by the Food and Drug Administration in 2003 and requires users to cut it to the proper shape prior to application, controlled bleeding in 25 of the cases (74%) within 3 minutes. User error was a factor in six of the seven failures.

"You have to make sure that you put the right side down on the wound in order for the hemostasis to occur," Dr. Putnam explained.

The other technology proving effective for external hemostasis includes products that contain zeolite, a derivative of volcanic rock. When applied to gauze and placed on wounds, zeolite works as a molecular sieve and captures all the water locally, creating an exothermic reaction, said Dr. Putnam, who is also associate director of the Harbor-UCLA Medical Center general surgery residency program.

"We think that it dehydrates the wound of all the water properties, leaving a high concentration of all the clot-promoting components: the coagulation factors, the proteins, the cells," he explained.

The zeolite-based product QuikClot (Z-Medica Corp.), developed in 2002, is currently approved for external use only. But Dr. Putnam and his associates have used it on rare occasions to help pack life-threatening bleeding from internal wounds such as those caused by high-velocity gunfire. "I don't recommend that—I'm just saying that when we were faced with the life or death choice, we used it as part of packing internally, and the patients did very well," he said.

A recent survey of QuikClot's use in 69 cases by the U.S. military in Iraq, in 20 cases by civilian trauma surgeons, and in 14 cases by civilian first responders demonstrated an overall efficacy of 92% (J. Trauma 2008;64:1093–9). The researchers speculated that the QuikClot failures were due to the coagulopathic state of a patient from massive resuscitation or the inability to get the product directly to the source of bleeding.

Dr. Putnam said that he had no relevant disclosures to make.

CORONADO, CALIF. — Two novel technologies are helping to control external bleeding when conventional methods such as direct pressure and gauze dressings fail.

These include products that contain chitosan or zeolite, Dr. Brant A. Putnam said at a meeting sponsored by the American College of Emergency Physicians.

Chitosan is a biodegradable, nontoxic carbohydrate derived from chitin, a naturally occurring substance. "It has a muco-adhesive property that binds everything together," said Dr. Putnam, chief of trauma and surgical care at Harbor-UCLA Medical Center in Torrance, Calif. "It probably activates platelets, and it may vasoconstrict locally. Then there are interactions with the red blood cell surface that we don't quite understand, so I'm sure there will be more research to follow."

Several animal studies have demonstrated its effectiveness as a hemostatic agent. In a human study published online Nov. 19, 2007, in the Journal of Emergency Medicine, paramedics used a hemostatic dressing made of chitosan (HemCon Bandage) in 34 wounds they couldn't control with direct pressure (doi:10.1016/j.jemermed.2007.05.043

The bandage, which was approved by the Food and Drug Administration in 2003 and requires users to cut it to the proper shape prior to application, controlled bleeding in 25 of the cases (74%) within 3 minutes. User error was a factor in six of the seven failures.

"You have to make sure that you put the right side down on the wound in order for the hemostasis to occur," Dr. Putnam explained.

The other technology proving effective for external hemostasis includes products that contain zeolite, a derivative of volcanic rock. When applied to gauze and placed on wounds, zeolite works as a molecular sieve and captures all the water locally, creating an exothermic reaction, said Dr. Putnam, who is also associate director of the Harbor-UCLA Medical Center general surgery residency program.

"We think that it dehydrates the wound of all the water properties, leaving a high concentration of all the clot-promoting components: the coagulation factors, the proteins, the cells," he explained.

The zeolite-based product QuikClot (Z-Medica Corp.), developed in 2002, is currently approved for external use only. But Dr. Putnam and his associates have used it on rare occasions to help pack life-threatening bleeding from internal wounds such as those caused by high-velocity gunfire. "I don't recommend that—I'm just saying that when we were faced with the life or death choice, we used it as part of packing internally, and the patients did very well," he said.

A recent survey of QuikClot's use in 69 cases by the U.S. military in Iraq, in 20 cases by civilian trauma surgeons, and in 14 cases by civilian first responders demonstrated an overall efficacy of 92% (J. Trauma 2008;64:1093–9). The researchers speculated that the QuikClot failures were due to the coagulopathic state of a patient from massive resuscitation or the inability to get the product directly to the source of bleeding.

Dr. Putnam said that he had no relevant disclosures to make.