Academic Department of Military Surgery & Trauma, Royal Centre for Defence Medicine, Birmingham, UK
06/11/2010
Point sur les pansements hémostatiques
Un article récent fait le tour des pansements hémostatiques.
Review
J. Granville-Chapman, N. Jacobs and M.J. Midwinter
Abstract
Background
Uncontrolled haemorrhage is a leading cause of prehospital death after military and civilian trauma. Exsanguination from extremity wounds causes over half of preven military combat deaths and wounds to the anatomical junctional zones provide a particular challenge for first responders. Commercial products have been developed, which claim to outperform standard gauze bandages in establishing and maintaining non-surgical haemostasis. Since 2004, two advanced haemostatic dressing products, HemCon and QuikClot have been widely deployed in military operations. Newer products have since become available which aim to provide more efficient haemostasis than and thus supersede HemCon and QuikClot.
Aim
To conduct a systematic review of clinical and preclinical evidence to compare the relative efficacy and safety of available haemostatic products, which are of relevance to pre-hospital military and civilian emergency medical providers.
Method
An English language literature search was performed, using PubMed® and Web of Knowledge® Databases, with cross-referencing, focussed product searches and communication with product manufacturers. For studies employing animal models, the injury model was required to produce fatal haemorrhage. Products were categorised by primary mode of action as either factor concentrators, mucoadhesive agents or procoagulant supplementors.
Results
From 60 articles collated, 6 clinical papers and 37 preclinical animal trials were eligible for inclusion in this review. Products have been tested in three different types of haemorrhage model: low pressure, high volume venous bleeding, high pressure arterial bleeding and mixed arterial-venous bleeding. The efficacy of products varies with the model adopted. Criteria for the ‘ideal battlefield haemostatic dressing’ have previously been defined by Pusateri, but no product has yet attained such status. Since 2004, HemCon (a mucoadhesive agent) and QuikClot (a factor concentrator) have been widely deployed by United States and United Kingdom Armed Forces; retrospective clinical data supports their efficacy. However, in some recent animal models of lethal haemorrhage, WoundStat (mucoadhesive), Celox (mucoadhesive) and CombatGauze (procoagulant supplementor) have all outperformed both HemCon and QuikClot products.
Conclusion
HemCon and QuikClot have augmented the haemostatic capabilities of the military first aid responder, but newer products demonstrate potential to be more effective and should be considered as replacements for current in service systems. These products could have utility for civilian pre-hospital care.
Keywords: Dressing; Battlefield; Haemostatic; Combat; Prehospital; WoundStat; QuikClot; HemCon; Celox; Combat Gauze
| Tags : pansement
12/10/2010
Tourniquet: Un algorithme
Le concept du garrot tactique est basé sur le fait que la pose d'un garrot est le moyen le plus simple pour arrêter une hémorragie des membres mais que l'indication doit être validé le plus tôt possible. Un algorithme visible ici peut être proposé.
11/10/2010
Contrôle préhospitalier des hémorragies externes
L'arrêt des hémorragies fait appel à la mise en oeuvre d'un ensemble de moyens représentés par la compression directe des plaies, la mise en place de pansements et de bandage compressifs, la rembourrage de plaie, l'emploi de pansements hémostatiques et la pose de garrrôts. (lire ce document)
07/12/2008
Au sujet des garrots
Forum garrot
| Tags : tourniquet, garrot, massive bleeding control