Wedmore Ian, McManus John G, Pusateri Anthony E, Holcomb John B
Madigan Army Medical Center, Fort Lewis, Washington, USA.
J Trauma. 2006 Mar;60(3):655-8. doi: 10.1097/01.ta.0000199392.91772.44.
Hemorrhage remains a leading cause of death in both civilian and military trauma patients. The HemCon chitosan-based hemostatic dressing is approved by the US Food and Drug Administration (FDA) for hemorrhage control. Animal data have shown the HemCon dressing to reduce hemorrhage and improve survival. The purpose of this article is to report preliminary results of the hemostatic efficacy of the HemCon dressing used in the prehospital setting on combat casualties.
A request for case information on use of HemCon dressings in Operation Iraqi Freedom and Operation Enduring Freedom was sent to deployed Special Forces combat medics, physicians, and physician assistants.
Sixty-eight uses of the HemCon dressing were reported and reviewed by two US Army physicians. Four of the 68 cases were determined duplicative resulting in a total of 64 combat uses. Dressings were utilized externally on the chest, groin, buttock, and abdomen in 25 cases; on extremities in 35 cases; and on neck or facial wounds in 4 cases. In 66% of cases, dressings were utilized following gauze failure and were 100% successful. In 62 (97%) of the cases, the use of the HemCon dressing resulted in cessation of bleeding or improvement in hemostasis. There were two reported dressing failures that occurred with blind application of bandages up into large cavitational injuries. Dressings were reported to be most useful on areas where tourniquets could not be applied to control bleeding. The dressings were reported to be most difficult to use in extremity injuries where they could not be placed easily onto or into the wounds. No complications or adverse events were reported.
This report on the field use of the HemCon dressing by medics suggests that it is a useful hemostatic dressing for prehospital combat casualties and supports further study to confirm efficacy.
出血仍然是 civilian 和 military 创伤患者死亡的主要原因。HemCon 壳聚糖基止血敷料已获美国食品药品监督管理局（FDA）批准用于控制出血。动物数据表明 HemCon 敷料可减少出血并提高生存率。本文的目的是报告在院前环境中用于 combat 伤员的 HemCon 敷料止血效果的初步结果。
向部署的特种部队 combat 医护人员、医生和医师助理发送了关于在伊拉克自由行动和持久自由行动中使用 HemCon 敷料的病例信息请求。
两名美国陆军医生报告并审查了 68 次 HemCon 敷料的使用情况。68 例中有 4 例被确定为重复病例，因此共有 64 次 combat 使用。敷料在 25 例中用于胸部、腹股沟、臀部和腹部的外部；在 35 例中用于四肢；在 4 例中用于颈部或面部伤口。在 66%的病例中，在纱布止血失败后使用了敷料，且 100%成功。在 62（97%）例病例中，使用 HemCon 敷料导致出血停止或止血改善。有两例报告的敷料使用失败，发生在盲目将绷带应用于大的空洞性损伤时。据报告，敷料在无法应用止血带控制出血的部位最有用。据报告，敷料在四肢损伤中最难使用，因为它们不容易放置在伤口上或伤口内。未报告并发症或不良事件。
本报告关于医护人员在实地使用 HemCon 敷料的情况表明，它是一种用于院前 combat 伤员的有用止血敷料，并支持进一步研究以确认其疗效。
