The use of hemostats to stop a massive hemorrhage | Hemorrhage control

Currently, most of the deaths occur as a result of polytrauma and hence the massive hemorrhages. It has been shown that more than 20% of prehospital deaths could have been avoided, with more than 90% due to massive hemorrhages.


Control a massive hemorrhage by accelerating the blood coagulation process


The majority of deaths are due to trunk hemorrhages, in more than one 60% of cases, at the point of union in more than 20%, and in limbs above 15%. The last protocols, put the C of the bleeding before the well-known ABC in prehospital first aid.

The massive hemorrhage not controlled properly, reduces the blood volume in the circulation, producing in many cases what is called "Mortal Triad" that is produced by the obstruction of the body microcirculation, from there the hypoxia of the brain and organs. The main complications that occur are acidosis, hypothermia and coagulopathy.

Advances in biotechnology have generated new topical hemostatic agents capable of controlling massive hemorrhages


In 2015, with the update of the protocols of the ERC (European Resuscitation Council) and the AHA (American Hearth Association) guidelines, reference is made to the use of hemostatic dressings and the control of massive bleeding. In this last decade advances in biotechnology have generated a considerable increase in the appearance of new topical hemostatic agents to help in the control of massive hemorrhages. These data come mainly from the military context where they are mainly of vital importance, since they represent the first cause of death in a war environment, being little known in the civil context.

What is a hemostatic agent?


In order to answer this question, we must first know the definition of "Hemostasis". According to Real academy of the Spanish language, the definition of "Hemostasis" It is the "stopping a hemorrhage spontaneously or by physical means, such as manual compression or the stick, or chemicals, such as drugs. "

Once we know this definition, we can better know that it is a hemostatic agent, which according to the Food and Drug Administration (FDA, for its acronym in English) of the US, defines as hemostatic agent, "That agent or device that is used for the purpose of producing hemostasis by accelerating the blood coagulation process".

There are factors to be taken into account in haemostatic agents: cheap and simple in its production, simple application, safe and without side effects after use, it must maintain its property is in extreme conditions and should be effective against moderate and severe bleeding.

Main hemostatic agents of the market and their characteristics


Among the hemostatic agents, the QuickClot. These dressings are excellent to stop a massive hemorrhage and control bleeding, approved by the Food and Drug Administration (FDA), are composed of a volcanic mineral of inert origin called zeolite. Absorption of the most water molecules occurs in 1-2 seconds and heat is released by an exothermic reaction. Due to this reaction and burns, they have produced a second derivative of the previous one that is QuickClot Advanced Clotting Sponge (ACS +), also formed by zeolite, which reduces the intensity of the exothermic reaction.

There are other agents that act by activating coagulation, among which is the Dry Fibrin Sealant (DFS) (Dry fibrin sealants) able to stop massive hemorrhage and control bleeding. Hemostats formed by 4 components, these dressings improve the coagulation of wounds by providing a high local concentration of coagulation factors. The disadvantages are its sticky consistency causing it to adhere to the gloves or hands of the person who applies them.

Combat Gauze (CG) It is a second generation dressing. It is a very flexible bandage or gauze formed 50% silk and 50% polyester impregnated with kaolin, clays rich in a mineral called kaolinite that has absorbing properties and activate coagulation. They produce an agglutination of red blood clotting factors and platelets that favors the formation of a clot stopping the hemorrhage. One of its drawbacks is that they do not produce an immediate haemostasis. It is very simple to apply and does not require specific procedures. There are already third-generation items on the market called Combat Gauze XL.

Celox (CE) The EC, as these hemostats are called, are composed of chitosan. They are marketed in four formats of employment, this dressing has a mechanism of action similar to the hemostatic agents mentioned above with which to control the massive bleeding. The Celox part with the advantage that also acts under conditions of hypothermia and in patients with anticoagulant treatment, acts independently of the coagulation factors. Easy to use and inexpensive price, its effectiveness in the treatment of severe bleeding places it in an advantageous position in the market.

Adrián Villar Calderón

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