If you are looking to update your medical kit with effective and proven products, consider adding hemostatic agents. Over the course of the wars in Iraq and Afghanistan trauma medicine has markedly improved with hemostatic gauze being one major advance. These clotting agents have proven so effective; they are standard in every medic’s trauma kit on the battlefield. As such, it is worth comparing the two most popular brands sold under the names QuickClot®Combat Gauze and Celox.
First of all, one should understand that clotting agents have been around for some time and have undergone an evolution in both composition and the mechanisms by which they work. Both Combat Gauze and Celox are the current result of this evolution and are far safer and more effective than their earlier ancestors. For example, the original QuickClot® essentially cauterized a wound with heat from a chemical reaction, which caused serious burns and contraindications. As a result, it was removed from medical kits and replaced with newer and better hemostatic agents. Today’s products are impregnated with hemostatic agents that facilitate blood clotting by complimenting or enhancing the body’s natural clotting faculties to stop massive hemorrhaging. Both Combat Gauze and Celox do this well, but which is best? Both also are used broadly by military, law enforcement, and rescue units around the world. However, these products are not cheap so if one is to invest in only one product, I recommend Celox for your medical kit.
Hemostatic agents in Combat Gauze and Celox allow for the formation of much larger clots than normal, which are more stable and more difficult to dislodge. This is critical for effective stoppage of heavy bleeding, especially, when a patient will have to be moved and clots could be jarred loose such as on the battle field. Further, both require the gauze to be used with constant firm pressure to be effective and allow the clot to form. Both are essentially used in the same manner. The specific location of the massive hemorrhage is located in the wound (usually a severed artery or large vein), is quickly wiped clean so that the wound location is identifiable, and the gauze is placed firmly and directly upon the bleed. For penetrating wounds such as gunshots, the cavity is then packed tightly being careful to maintain constant pressure on the bleed location while completely filling the void with tightly packed gauze. The packing is then held in place with a compression dressing. The gauze should be so tightly packed that it forms a gauze golf ball in the wound channel. The critical aspect for effective application of both products relies on their correct placement on the bleeding vein or artery and the maintenance of constant pressure until the bleeding stops. It is also worth noting that plain sterile gauze packed in a wound in the same manner using direct pressure is also still highly effective for stopping hemorrhaging.
Even though both products essentially are used the same way, Celox has notable advantages. First, in tests and operational employment, the Celox simply worked better at stopping serious bleeds. When similar wounds were unpacked in a surgical setting, it was clear from the degree of blood saturation that far less blood was lost in a patient when Celox was used. Specifically, in like wounds that severed the femoral artery of patients, Combat Gauze was unpacked and laid out showing over 12 yards of blood saturation whereas Celox showed approximately 12 inches before the gauze was blood free. This large difference could mean the difference between decompensated shock induced by severe blood loss and then the death of a patient or the complete prevention of hemorrhagic shock and survival of the patient. Further, the thicker Z-Folded Celox was much easier to handle and pack into wounds than the old school style of rolled Combat Gauze. Nothing is worse than having an entire roll of sterile gauze unwind into the muck on the ground just as you are trying to pack the wound of a severely hemorrhaging patient.
Evaluations of wounds treated with Celox and Combat Gauze also revealed that the clots formed by Celox tended to be larger and more stable. This may be due to how Celox and Combat Gauze clot. With Celox, the clotting agents are inherent in the compound so that they react instantly when they come into contact with blood. However, Combat Gauze relies upon concentrating the body’s own clotting agents (platelets) as they contact, accumulate, and react with the gauze. This is problematic since often, as a body enters shock from blood loss; the body naturally shunts blood flow from the core preventing the critical clotting compounds from reaching the wound site and the gauze. Further, when intravenous fluids are given without the addition of platelets, it reduces the effectiveness of Combat Gauze’s clotting mechanism because the fluid dilutes the blood’s natural clotting compounds.
Celox and Combat Gauze both help blood to begin clotting, but Celox is designed to work across a much broader range of patients. Specifically, Combat Gauze is designed to work with the narrow body chemistry of healthy fighting age patients. Celox on the other hand is designed to be effective across a much greater range of patients to include geriatric, those taking medications, and those taking blood thinners. This alone makes Celox a better “civilian” choice where it is more likely the patient will not fit into the perfect physically fit specimen of a fighting age soldier. In short, Celox employs a hemostatic agent that applies to everyone, whereas Combat Gauze is only designed to be effective in healthy fighting age soldiers.
In the recent DoD comparative study, Celox Gauze had the least overall blood loss, the highest survival and the highest overall hemostasis of all products. This study corresponds to the empiric evidence that I have gathered over the years using a variety of these products operationally.
By Guiles Hendrik
July 8, 2014
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