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Effectiveness of kaolin-impregnated hemostatic gauze
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Effectiveness of kaolin-impregnated hemostatic gauze
Between May 2014 and October 2018, 53 of 75 patients who underwent PPP due to hemodynamic instability induced by pelvic fracture were enrolled. Their medical records were prospectively collected and retrospectively analyzed. QuikClot combat gauze (hydrophilic gauze impregnated with kaolin) and general surgical tape were used in 21 patients, while general surgical tape was used in the remaining 32 patients.To get more news about combat gause, you can visit rusuntacmed.com official website.
Results
As there were differences in the characteristics of patients between the hemostatic gauze (HG) group and control group, propensity score matching (PSM) was performed to adjust for age, sex, and lactate levels. After PSM, the clinical characteristics between the two groups became similar. There were no differences in the rates of mortality and hemorrhage-induced mortality between the two groups. However, the packed red blood cell (RBC) requirement for an additional 12 hours in the HG group was significantly lower than that in the control group (4.1 ± 3.5 vs. 7.6 ± 6.1 units, p = 0.035). The lengths of intensive care unit and hospital stays tended to be shorter in the HG group than in the control group (11.6 vs. 18.5 days, p = 0.1582; 30.8 vs. 47.4 days, p = 0.1861, respectively).
Conclusions
The use of HG during PPP did not reduce hemorrhage-induced mortality, but did reduce the need for additional packed RBC transfusions in patients with hemodynamic instability due to severe pelvic fractures.
1 Introduction
The mortality rate in patients with hemodynamic instability due to pelvic bone fractures remains high despite the development of several hemostatic modalities [1–5]. Recent studies have shown that preperitoneal pelvic packing (PPP) can be an effective hemostatic method for damage control surgery [6–8].Among commercially available hemostatic gauzes, QuikClot Combat Gauze (QCG; Z-Medica, Wallingford, CT, USA), a hydrophilic gauze impregnated with kaolin, enhances hemostasis by activating the intrinsic pathway. It was first used in trauma cases with hemorrhaging external wounds but has recently been used for patients with intracorporeal hemorrhage [9, 10].
A study using a hypothermic coagulopathic swine model showed that, compared to plain gauze, kaolin-impregnated gauze for packing in cases of high-grade liver injuries reduced postoperative hemorrhage [11].
The present study aimed to evaluate the effectiveness of kaolin-impregnated hemostatic gauze in PPP for patients with hemodynamic instability due to severe pelvic fractures.
2 Material and methods
2.1 Patient selection and data collection
This retrospective study was approved by the institutional review board of a tertiary university hospital (IRB no. CR319078). Medical data of patients with pelvic fractures were collected from the hemodynamically unstable pelvic bone fracture registry of this tertiary university hospital, which is part of the Korean Trauma Data Bank. Data were collected prospectively and analyzed retrospectively. Because the data were analyzed anonymously, informed consent was waived. The inclusion criteria were: 1) hemodynamically unstable pelvic fracture, and 2) age > 19 years. Seventy-five patients with hemodynamic instability due to pelvic fractures who were admitted to the regional trauma center of the tertiary university hospital between May 2014 and October 2018 were enrolled in the study. After the exclusion of 22 patients who did not receive PPP, 53 patients were included. These patients were divided into a hemostatic gauze group (HG group, n = 22) and a control group (n = 31) (Fig 1). Hemostatic gauze was commonly used as a standard of care in our hospital. When performing PPP, there were no criteria for the use of hemostatic gauze and its use was determined by the surgeon.
2.2 Patient management
Hemodynamic instability was defined as persistent hypotension (systolic blood pressure < 90 mmHg), even after 2 L of crystalloid loading or transfusion of 2 units of packed red blood cells (RBCs). When patients were admitted to the trauma bay with pelvic bone fractures and hemodynamic instability, they underwent extended focused assessment with sonography for trauma and a trauma series of X-rays (lateral cervical spine, chest anteroposterior [AP], and pelvis AP). Thoracoabdominal injuries were evaluated using the images. Based on the results, emergency thoracotomy or laparotomy was performed. After pelvic binders were applied to reduce pelvic volume, PPP was performed for patients with pelvic ring injuries based on pelvic AP imaging results. Orthopedic surgeons on the trauma team then determined whether external fixation of the pelvic fractures should be performed. The management protocol for hemodynamically unstable pelvic fractures was initiated in our trauma center in May 2014 according to management protocols created by the Rocky Mountain Regional Trauma Center at Denver Health .