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09/10/2018

Pansement hémostatiqu: Emploi ciblé pour les + graves ?

Catastrophic haemorrhage in military major trauma patients: a retrospective database analysis of haemostatic agents used on the battlefield.

Winstanley M Winstanley  et Al. J R Army Med Corps. 2018 Oct 3. pii: jramc-2018-001031

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Une publication qui mettrait en évidence l'intérêt des pansements hémostatiques avec une amélioration de la survie des blessés les plus graves. A prendre quand même avec du recul car les derniers blessés inclus le sont sur une période de plus de 10 ans et qu'entre temps beaucoup d'évolution ont eu lieu notamment pour le QUIKCLOT  concurrent américain du CELOX qui lui est britannique. Comme pour les tourniquets où les contrefaçons foisonnent, les enjeux financiers liés à la promotion de tel pansement ou d'un autre sont colossaux dès lors que le marché civil s'ouvre à eux. On rappelle quand même qu'un bon packing de plaie avec un bon pansement compressif représentent la base.

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OBJECTIVES:

Catastrophic haemorrhage is a leading cause of morbidity and mortality in trauma, in both military and civilian settings. There are numerous studies looking at the effectiveness of different haemostatic agents in the laboratory but few in a clinical setting. This study analyses the use of haemostatic dressings used in patients injured on the battlefield and their association with survival.

METHOD:

A retrospective database review was undertaken using the UK Joint Theatre Trauma Registry from 2003 to 2014, during combat operations in Iraq and Afghanistan. Data included patient demographics, the use of haemostatic dressings, New Injury Severity Score (NISS) and patient outcome.

RESULTS:

Of 3792 cases, a haemostatic dressing was applied in 317 (either Celox, Hemcon or Quickclot). When comparing patients who had a haemostatic dressing applied versus no haemostatic agent, there was a 7% improvement in survival. Celox was the only individual haemostatic dressing that was associated with a statistically significant improvement in survival, which was most apparent in the more severely injured (NISS 36-75).

CONCLUSION:

We have shown an association between use of haemostatic agents and improved survival, mostly in those with more severe injuries, which is particularly evident in those administered Celox. This supports the continued use of haemostatic agents as part of initial haemorrhage control for patients injured in conflict and suggests that civilian organisations that may need to deal with patients with similar injury patterns should consider their use and implementation.

| Tags : packing

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