Evaluation of Xstat and Combat Gauze in a Swine Model of Lethal Junctional Hemorrhage in Coagulopathic Swine

Background: Hemorrhage is associated with the majority of potentially survivable deaths on the battlefield. Effective and field tested products are lacking to treat junctional and noncompressible injuries. XStat is a newly developed, FDA-approved product designed to treat junctional hemorrhage. The product is composed of mini sponges that expand on contact with blood to produce tamponade. The committee on tactical combat casualty care has recently approved the product for use as part of its treatment guidelines, but data is lacking to assess its efficacy in different wounding patterns and physiologic states. Methods: Large (70-90kg) male swine were used in all experiments. Dilutional coagulopathy was induced by replacing 60% of the animal's estimated blood volume with room temperature Hextend. Following dissection, isolation, and lidocaine incubation, uncontrolled hemorrhage was initiated by transection of both axillary artery and vein. Free bleed was allowed to proceed for 30 seconds until intervention with either XStat or Combat Gauze followed by standard backing. Primary outcomes were survival,hemostasis, and blood loss. Results: Nineteen, healthy animals were entered into the study. XStat-treated animals achieved hemostasis in less time and remained hemostatic longer than Combat Gauze. Less blood was lost during the first 10 minutes following injury in the XStat group than the Combat Gauze group. However, no differences were observed between XStat-treated and Combat Gauze-treated groups based on survival. All animals died before the end of the observation period except one in the XStat-treated group. Conclusions: The results presented here show XStat performed better than Combat Gauze in this model of junctionalhemorrhage in coagulopathic animals. Continued testing and evaluation of XStat should be performed to optimize application and to determine appropriate indications for use. Journal of Special Operations Medicine , 01 Jan 0001, 01 Jan 0001,