Catastrophic haemorrhage in military major trauma patients: a retrospective database analysis of haemostatic agents used on the battlefield.
Journal of the Royal Army Medical Corps · 2018-10-03 · Registry study
Abstract
OBJECTIVES: Catastrophic haemorrhage is a leading cause of morbidity and mortality in trauma, in both military and civilian settings. There are numerous studies looking at the effectiveness of different haemostatic agents in the laboratory but few in a clinical setting. This study analyses the use of haemostatic dressings used in patients injured on the battlefield and their association with survival. METHOD: A retrospective database review was undertaken using the UK Joint Theatre Trauma Registry from 2003 to 2014, during combat operations in Iraq and Afghanistan. Data included patient demographics, the use of haemostatic dressings, New Injury Severity Score (NISS) and patient outcome. RESULTS: Of 3792 cases, a haemostatic dressing was applied in 317 (either Celox, Hemcon or Quickclot). When comparing patients who had a haemostatic dressing applied versus no haemostatic agent, there was a 7% improvement in survival. Celox was the only individual haemostatic dressing that was associated with a statistically significant improvement in survival, which was most apparent in the more severely injured (NISS 36-75). CONCLUSION: We have shown an association between use of haemostatic agents and improved survival, mostly in those with more severe injuries, which is particularly evident in those administered Celox. This supports the continued use of haemostatic agents as part of initial haemorrhage control for patients injured in conflict and suggests that civilian organisations that may need to deal with patients with similar injury patterns should consider their use and implementation.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Haemostatic dressings & wound packing · Military & tactical · Mortality & survival
Related articles
- QuikClot® Combat Gauze® Use by Ground Forces in Afghanistan The Prehospital Trauma Registry Experience. (J Spec Oper Med, 2017)
- A systematic review of the use of tourniquets and topical haemostatic agents in conflicts in Afghanistan and Iraq. (J R Nav Med Serv, 2015)
- Prehospital use of hemostatic dressings by the Israel Defense Forces Medical Corps: A case series of 122 patients. (J Trauma Acute Care Surg, 2015)
- New hemostatic agents in the combat setting. (Transfusion, 2009)
- Prehospital Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in Patients with Major Trauma and Cardiac Arrest: A Systematic Review. (Prehosp Emerg Care, 2026)
- Use of Low-Titer O-Positive Whole Blood in Female Trauma Patients: A Literature Review, Qualitative Multidisciplinary Analysis of Risk/Benefit, and Guidelines for Its Use as a Universal Product in Hemorrhagic Shock. (J Am Coll Surg, 2024)