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Systematic review of prehospital haemostatic dressings
  1. Matthew Welch1,
  2. J Barratt2,
  3. A Peters3 and
  4. C Wright2
  1. 1 OUCAGS, University of Oxford, Oxford, UK
  2. 2 Emergency Department, St Mary’s Hospital Foundation Trust, London, UK
  3. 3 Severn Valley Academic Foundation Programme, Southmead Hospital, Bristol, United Kingdom
  1. Correspondence to Matthew Welch, University of Oxford, Oxford OX1 1DW, UK; matthew.welch1{at}nhs.net

Abstract

Introduction Haemorrhage is one of the leading causes of battlefield and prehospital death. Haemostatic dressings are an effective method of limiting the extent of bleeding and are used by military forces extensively. A systematic review was conducted with the aim of collating the evidence on current haemostatic products and to assess whether one product was more effective than others.

Methods A systematic search and assessment of the literature was conducted using 13 health research databases including MEDLINE and CINAHL, and a grey literature search. Two assessors independently screened the studies for eligibility and quality. English language studies using current-generation haemostatic dressings were included. Surgical studies, studies that did not include survival, initial haemostasis or rebleeding and those investigating products without prehospital potential were excluded.

Results 232 studies were initially found and, after applying exclusion criteria, 42 were included in the review. These studies included 31 animal studies and 11 clinical studies. The outcomes assessed were subject survival, initial haemostasis and rebleeding. A number of products were shown to be effective in stopping haemorrhage, with Celox, QuikClot Combat Gauze and HemCon being the most commonly used, and with no demonstrable difference in effectiveness.

Conclusions There was a lack of high-quality clinical evidence with the majority of studies being conducted using a swine haemorrhage model. Iterations of three haemostatic dressings, Celox, HemCon and QuikClot, dominated the studies, probably because of their use by international military forces and all were shown to be effective in the arrest of haemorrhage.

  • haemostatic
  • trauma
  • prehospital
  • haemorrhage
  • military
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Footnotes

  • Presented at The study has appeared in poster form at the RSM Colt Foundation Military Research Meeting.

  • Contributors MW and JB are joint first authors; they conducted the experiment and drafted the study. AP contributed to writing the results, discussion and conclusions, as well as assisting in editing and formatting. CW reviewed the study, made additions and corrections, and formatted the paper in a scientific style.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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