QuikClot Combat Gauze

QuikClot is a brand of hemostatic wound dressing that contains an agent that promotes blood clotting. The brand is owned by Teleflex.[1] It is primarily used by militaries and law enforcement to treat hemorrhaging from trauma.

History

The use of a sterilized molecular sieve material, such as zeolite, in a binding material to treat wounds was patented by Frank Hursey in 1989.[2] Following the September 11 attacks, the US armed forces conducted a study comparing different antihemorrhagic technologies, in which QuikClot received the best score.[3] Another study found that when used to treat lethal groin injuries in swine, the treated animals had a 100% survival rate.[4] Following these tests, the US armed forces approved its use in Afghanistan and Iraq.

Zeolite

The original formulation of the product contained the active ingredient zeolite, which promoted blood clotting. The zeolite would have an exothermic (heat-releasing) reaction with blood during the clotting process, which could cause second-degree burns.[5] Because of this, the product was not available for retail and was only used in emergency scenarios, such as in combat. Newer zeolite formulas come pre-hydrated, which produce less heat, and can be used more safely to pack wounds and stop hemorrhage.

Kaolin

By 2009, QuikClot devices were made of gauze impregnated with kaolin instead of using zeolite. The kaolin device performed equivalently to previously developed hemostatic bandages.[6] Kaolin doesn't trigger skin allergies due to its inert (nonreactive) characteristics.[7]

Mechanism

QuikClot was originally available as a granulate to be poured directly on a wound to stem bleeding.

The Kaolin in QuikClot Interventional bandages absorb the water molecules in blood, leaving behind the relatively bigger platelets and clotting factor molecules. The higher concentration of these remaining cells and molecules cause them to naturally clot faster.[8] Kaolin activates factor XII, a protein factor which assists in the initiation of the coagulation cascade, a protein chain reaction which promotes blood clotting as a result of trauma. Later, QuikClot was formulated using zeolite beads, which promoted clotting directly through activation of the coagulation cascade.[9]

Use by the US military

In the Tactical Combat Casualty Care Guidelines published by the CoTCCC (Committee on Tactical Combat Casualty Care) in 2014, QuikClot Combat Gauze was listed as the ideal hemostatic dressing to be used for external hemorrhage not amenable to tourniquet use or as an adjunct to tourniquet removal if evacuation time is anticipated to be longer than 2 hours.[10] In the TCCC Guidelines published in 2021, Combat Gauze remained the choice hemostatic dressing for such an injury.[11]

References

  1. ↑ Quickclot. About Teleflex
  2. ↑ US patent 4822349, Francis X. Hursey & Fernand J. Dechene, "Method of treating wounds", published 1989-04-18, issued 1989-04-18
  3. ↑ Alam, Hasan B; Uy, Gemma B; Miller, Dana; Koustova, Elena; Hancock, Timothy; Inocencio, Ryan; Anderson, Daniel; Llorente, Orlando; Rhee, Peter (June 2003). "Comparative Analysis of Hemostatic Agents in a Swine Model of Lethal Groin Injury". The Journal of Trauma: Injury, Infection, and Critical Care. 54 (6): 1007–1082. doi:10.1097/01.TA.0000068258.99048.70.
  4. ↑ Alam, Hasan B; Chen, Zheng; Jaskille, Amin; Querol, Racel Ireno Luis C; Koustova, Elena; Inocencio, Ryan; Conran, Richard; Seufert, Adam; Ariaban, Nanna; Toruna, Kevin; Rhee, Peter (May 2004). "Application of a Zeolite Hemostatic Agent Achieves 100% Survival in a Lethal Model of Complex Groin Injury in Swine". The Journal of Trauma: Injury, Infection, and Critical Care. 56 (5): 974–83. doi:10.1097/01.ta.0000127763.90890.31.
  5. ↑ Wright, James K.; Kalns, John PhD; Wolf, Edward A. MA; Traweek, Frederick BS; Schwarz, Stacy; Loeffler, CleAnn K. BS; Snyder, William; Yantis, Loudon D. Jr.; Eggers, Jeffrey (August 2004). "Thermal injury resulting from application of a granular mineral hemostatic agent". The Journal of Trauma: Injury, Infection, and Critical Care. 57 (2): 224–230. doi:10.1097/01.TA.0000105916.30158.06.
  6. ↑ Ronald E. Peterson (8 April 2009). K090620 510(k) Summary (PDF) (Report). FDA. p. 1. Retrieved 26 April 2023. The hemostatic pad is a hemostatic dressing made of soft, white, kaolin impregnated gauze, configured in a 1½" long by 1½" wide by ½" thick multi-layer pad.
  7. ↑ Trabattoni, Daniela; Montorsi, Piero; Fabbiocchi, Franco; Lualdi, Alessandro; Gatto, Pamela; Bartorelli, Antonio L. (9 April 2011). "A new kaolin-based haemostatic bandage compared with manual compression for bleeding control after percutaneous coronary procedures". European Radiology. 21 (8): 1687–91. doi:10.1007/s00330-011-2117-3.
  8. ↑ Politi, Luigi; Aprile, Alessandro; Paganelli, Catia; Amato, Andrea; Zoccai, Giuseppe B; Sgura, Fabio; Monopoli, Daniel; Rossi, Rosario; Modena, Maria G; Sangiorgi, Giuseppe M (February 2011). "Randomized clinical trial on short-time compression with kaolin-filled pad: a new strategy to avoid early bleeding and subacute radial artery occlusion after percutaneous coronary intervention". Journal of Interventional Cardiology. 24 (1): 65–72. doi:10.1111/j.1540-8183.2010.00584.x. hdl:11380/649198.
  9. ↑ Kay C Dee Ph.D.; David A. Puleo Ph.D.; Rena Bizios Ph.D. (23 August 2002). An Introduction To Tissue‐Biomaterial Interactions: Tissue‐Biomaterial. Hoboken, New Jersey: John Wiley & Sons, Inc. doi:10.1002/0471270598. ISBN 9780471253945.
  10. ↑ "Tactical Combat Casualty Care Guidelines" (PDF). 2 June 2014. Archived from the original (PDF) on 23 June 2015. Retrieved 25 March 2015.
  11. ↑ "Tactical Combat Casualty Care (TCCC) Guidelines for Medical Personnel" (PDF). Journal of Special Operations Medicine. 22 (1): 11–17. 15 December 2021. doi:10.55460/ETZI-SI9T.
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