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Exothermic Reaction in Zeolite Hemostatic Dressings: QuikClot ACS and ACS+®

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Abstract

Background Zeolites have hemostatic properties used to stop bleeding in severe hemorrhage. Manufactured QuikClot® is an approved zeolite-based hemostatic agent for battlefield use. The exothermic reaction associated with QuikClot as loose granules or as granules packaged in a mesh bag has potential burn effects; this led to the development of a formulation of “cooler” non-exothermic QuikClot. The goal of this study was to compare the elevation of temperature of these formulations upon contact with blood. Methods Following full transection of the femoral vasculature, anesthetized Yorkshire pigs (n = 15) (28.8 ± 1.5 kg) were hemorrhaged for 2 min and treated with 100 g of bagged QuikClot (Advanced Clotting Sponge (ACS) (n = 4)) or a modified non-exothermic formulation (ACS+ (n = 11)). Vital signs and temperature at the dressing/tissue interface were continuously recorded for 3 h. Additional procedures were used to examine effects of different ratios of blood to zeolite on temperature elevation. Results Total post-treatment blood loss was comparable for ACS+_E and ACS_E groups (overall average: 18.6 ± 10.5% EBV). Temperature recorded at the dressing/tissue interface was significantly lower with ACS+ vs. ACS (40.3 ± 1.8 vs. 61.4 ± 10.7 °C, respectively, p < 0.01) and was 3.2 ± 2.6 °C higher than rectal temperature (38.0 ± 0.7 °C, p < 0.01). Survival at endpoint (7/11 vs. 4/4) and average survival time (134 ± 64 vs. 180 min) were greater for both ACS+ and ACS in comparison to Standard Dressing. The wound temperature with ACS was reduced with greater blood to product ratios and this pattern was paralleled with in vitro measurements. Conclusions The lower heat release with ACS+ compared to ACS was confirmed in an animal model and ACS+ had similar efficacy in arresting bleeding when compared to Standard Dressing.

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Acknowledgments

Test materials were provided by Z-Medica, Wallingford, CT (ACS, ACS+); and H and H Associates, Inc., Bena, VA (standard dressing). The authors wish to thank M. Hammett, D. Fasipe, B. Esperat and N. Carballo for technical assistance. Z-Medica, Wallingford, CT for providing QuikClot® products, MARCORSYSCOM for funding this study.

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Authors and Affiliations

  1. Department of Trauma and Resuscitative Medicine, Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, MD, 20910-7500, USA

    Françoise Arnaud, Toshiki Tomori, Walter Carr, Anne McKeague, Kohsuke Teranishi, Keith Prusaczyk & Richard McCarron

  2. Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

    Richard McCarron

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  1. Françoise Arnaud
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  2. Toshiki Tomori
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  3. Walter Carr
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  4. Anne McKeague
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  5. Kohsuke Teranishi
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  6. Keith Prusaczyk
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  7. Richard McCarron
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Correspondence to Françoise Arnaud.

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The views expressed in this article are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the U.S. Government.

Authors are military service member or employees of the U.S. Government. This work was prepared as part of official duties. Title 17 U.S.C. §105 provides that ‘Copyright protection under this title is not available for any work of the United States Government.’ Title 17 U.S.C. §101 defines a U.S. Government work as a work prepared by a military service member or employee of the U.S. Government as part of that person’s official duties.

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Arnaud, F., Tomori, T., Carr, W. et al. Exothermic Reaction in Zeolite Hemostatic Dressings: QuikClot ACS and ACS+® . Ann Biomed Eng 36, 1708–1713 (2008). https://doi.org/10.1007/s10439-008-9543-7

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  • DOI: https://doi.org/10.1007/s10439-008-9543-7

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