Table 1

Prehospital clinical studies using current haemostatics24–34

Lead author,
year
Background
  • Location/type of injuries

  • Type of bleeding

Subject (n)Test agentsSurvival (%)Initial haemostasis achievedRebleeding
Wedmore et al 24
2006
Review of combat usage by US SOF in Iraq and Afghanistan. Application time and pressure not given.
  • 35 extremities, 25 trunk/groin/buttocks/abdomen

  • 7 arterial; 33 venous; 24 unknown

64HCG (n=64)97%1.5%
Brown et al 25
2007
Case series of paramedic use. Application time and pressure ‘not standardised’
  • 13 head/neck/face injuries; 18 extremities; 1 abdomen; 1 axial; 1 chest

  • 12 arterial; 13 venous; 9 unknown

34HCG (n=34)79% (27/34)
6/7 failures attributed to user error
Cox et al 26
2009
Retrospective case series of battlefield/field hospital uses of HemCon and QuikClot from notes. Application time and pressure not given. 34 patients treated in ED; 8 on the battlefield
  • 26 trunk (including intra-abdominal/thoracic); 7 extremities

  • 7 arterial; 8 venous; 8 combined; 4 solid organ; 15 indeterminate

41HCG (n=40)95>95%
Ran et al 27
2010
14 uses of QuikClot from the battlefield. Application followed by a ‘regular dressing and pressure’
  • 10 head/neck/axilla/buttocks/abdomen/back/pelvis; 4 extremities

  • 13 (93%) blast or gunshot

  • 3 failures were attributed to severe soft tissue and vascular injuries.

14QCG (n=14)93 (though not explicitly stated)79% (11/14)
Pozza et al 28
2011
21 soldiers with gunshots treated with Celox at a field hospital. Celox applied followed by gauze and pressure for 2 min
  • 17 extremities; 1 neck

  • 15 already had tourniquets applied

21Cx (n=21)86% (18/21)
King and Schreiber29
2011
2 case reports, one from battlefield IED explosion, one civilian multiple gunshot wounds. Application time and pressure not given
  • 1 extremity; 1 groin

  • 1 venous; 1 unknown

2MRDH (n=2)100%100%
Tan and Bleeker30
2011
Review of use of Celox in Netherlands (HEMS) and Afghanistan. After application, manual pressure applied for 5 min then covered with an occlusive bandage. 3 prehospital; 4 battlefield
  • 2 extremities; 2 head/neck; 3 junctional

7Cx (n=7)86% (6/7)
King31
2011
Review of usage by surgical team in a forward operating theatre in Iraq. Application time and pressure not given
  • Multiple injuries including intra-abdominal organ lacerations, vena cava laceration as well as peripheral injuries

  • 68% penetrating injuries, 45% blast injuries

19MRDH (n=19)84%19%
Travers et al 32
2016
30 uses of QuikClot QCG by prehospital clinical teams. Application time and pressure not given
  • 15 penetrating wounds (including 1 gunshot wound); 4 falls; 3 RTC

  • 16 head/neck injuries

  • 19 arterial bleeds; 6 venous; 5 unknown

30QCG (n=30)8093%73%
Shina et al 33
2015
122 cases from battlefield injuries. Application time and pressure not given
  • 104 penetrating injuries; 4 blunt; 14 combined

  • 37 junctional wounds; 63 extremities; 4 head/neck; 10 chest; 1 abdomen

122QCG (n=122)93.290.7%
Hatamabadi et al 34
2015
RCT of Celox versus standard gauze in prehospital penetrating limb trauma. Application time and pressure not given
  • Predominantly peripheral penetrating injuries greater than 3 cm

160Cx (n=80)
SG (n=80)
61.2%
38.8%
(haemostasis in
<5 min)
  • .Cx, Celox; ED, emergency department; HCG, HemCon Chitogauze/Chitoflex/RTS; HEMS, Helicopter Emergency Medical Services; IED, improvised explosive device; MRDH, Modified Rapid Deployment Hemostat; QCG, QuikClot Combat Gauze; RCT, randomised controlled trial; RTC, road traffic collision; SG, standard gauze; SOF, Special Operations Forces.