Stuart Sean M, Zarow Gregory, Walchak Alexandra, McLean Julie, Roszko Paul
Naval Medical Center Portsmouth, 620 John Paul Jones Cir, Portsmouth, VA.
Mil Med. 2019 Mar 1;184(Suppl 1):367-373. doi: 10.1093/milmed/usy337.
Exsanguinating hemorrhage is a primary cause of battlefield death. The iTClamp is a relatively new device (FDA approval in 2013) that takes a different approach to hemorrhage control by applying mechanism wound closure. However, no previous studies have explored the feasibility of utilizing the iTClamp in conjunction with hemostatic packing. To fill this important gap in the literature, a novel swine model was developed, and a total of 12 trials were performed using QuikClot Combat Gauze or XSTAT sponges in conjunction with the iTClamp to treat arterial injuries through 5 cm or 10 cm skin incisions in the groin, axilla, or neck. First-attempt application success rate, application time, and blood loss were recorded. Hemostasis was achieved on all wounds, though reapplication was required in one Combat Gauze and three XSTAT applications. Application averaged ~50% slower for Combat Gauze (M = 41 seconds, 95%CI: 22-32 seconds) than for XSTAT (M = 27 seconds, 95%CI: 35-47 seconds). XSTAT application was faster than Combat Gauze for each wound location and size. The 10 cm wounds took ~10 seconds (36%) longer to close (M = 27 seconds, 95%CI: 35-47 seconds) than the 5 cm wounds (M = 27 seconds, 95%CI: 35-47 seconds). Blood loss was similar for Combat Gauze (M = 51 mL, 95%CI: 25-76 mL) and XSTAT (M = 60 mL, 95%CI: 30-90 mL). Blood loss was roughly twice as great for 10 cm wounds (M = 73 mL, 95%CI: 47-100 mL) than for 5 cm wounds (M = 38 mL, 95%CI: 18-57 mL). This pilot study supports the feasibility of a novel model for testing the iTClamp in conjunction with hemostatic packing towards controlling junctional hemorrhage.
失血性出血是战场死亡的主要原因。iTClamp是一种相对较新的设备（2013年获得美国食品药品监督管理局批准），它通过应用机械伤口闭合的方法来控制出血，采取了不同的途径。然而，以前没有研究探讨过将iTClamp与止血填料联合使用的可行性。为了填补文献中的这一重要空白，开发了一种新型猪模型，并使用QuikClot战斗纱布或XSTAT海绵与iTClamp联合进行了总共12次试验，通过腹股沟、腋窝或颈部5厘米或10厘米的皮肤切口来治疗动脉损伤。记录首次应用成功率、应用时间和失血量。所有伤口均实现止血，不过有一次战斗纱布应用和三次XSTAT应用需要重新应用。战斗纱布的应用平均比XSTAT慢约50%（中位数 = 41秒，95%置信区间：22 - 32秒）（XSTAT中位数 = 27秒，95%置信区间：35 - 47秒）。对于每个伤口位置和大小，XSTAT的应用都比战斗纱布快。10厘米的伤口闭合时间比5厘米的伤口长约10秒（36%）（中位数 = 27秒，95%置信区间：35 - 47秒）（5厘米伤口中位数 = 27秒，95%置信区间：35 - 47秒）。战斗纱布（中位数 = 51毫升，95%置信区间：25 - 76毫升）和XSTAT（中位数 = 60毫升，95%置信区间：30 - 90毫升）的失血量相似。10厘米伤口的失血量（中位数 = 73毫升，95%置信区间：47 - 100毫升）大约是5厘米伤口（中位数 = 38毫升，95%置信区间：18 - 57毫升）的两倍。这项初步研究支持了一种新型模型的可行性，该模型用于测试iTClamp与止血填料联合控制交界性出血。
