Is Intraoperative Use of QuikClot Combat Gauze Effective for Hemostasis after Total Knee Arthroplasty?

BACKGROUND: To assess the hemostatic effect of QuikClot Combat Gauze (QCG) compared to that of standard gauze during cruciate-retaining total knee arthroplasty (TKA). METHODS: Sixty knees underwent TKA using a pneumatic tourniquet in this prospective randomized study. After implantation of the femoral and tibial components and hardening of the bone cement, the tourniquet was deflated and QCG (group 1) or standard gauze (group 2) was packed into the joint cavity for 5 minutes for hemostasis. Perioperative bleeding volume and blood transfusion volume were compared between two groups. RESULTS: The mean intraoperative bleeding volume was 64.7 ± 12.7 mL in group 1 and 63.9 ± 9.2 mL in group 2 (p = 0.808). The mean postoperative blood drainage was 349.0 ± 170.6 mL in group 1 and 270.1 ± 136.3 mL in group 2 (p = 0.057). The average postoperative blood transfusion volume was 323.7 ± 325.9 mL in group 1 and 403.6 ± 274.8 mL in group 2 (p = 0.314). CONCLUSIONS: QCG was not significantly effective for reducing perioperative bleeding volume or the blood transfusion rate compared with standard gauze during TKA.

The Efficacy of QuikClot Combat Gauze, Fluid Resuscitation and Movement on Hemorrhage Control in a Porcine Model of Hypothermia.

Aims: The purpose of this study was to compare the effectiveness QuikClot Combat Gauze (QCG) to a control group on hemorrhage control and investigate the effects of intravenous volume resuscitation on rebleeding and movement on hemostasis in a porcine model of hypothermia. Design: This was a prospective, between subjects, experimental design. Twenty-two Yorkshire swine were randomly assigned to two groups: QCG (n = 11) or control (n=11). Methods: The femoral artery and vein were transected. After 1 minute of uncontrolled hemorrhage, the hemostatic agent QCG was placed into the wound followed by standard wound packing. The control group underwent the same procedures without QCG. After 5 minutes of manual pressure, a pressure dressing was applied to the injury site. Initial resuscitation was performed with 500 mL of rapidly administered IV 6% Hetastarch. Following 30 minutes of observation, the dressings were removed and any additional blood loss was collected and total blood loss calculated. Hemostasis was defined as <2% total blood volume or ~ 100 mL in a 70 kg swine. If hemostasis occurred, 5 Liters of IV crystalloid were rapidly administered and the wound was again observed for rebleeding. If no bleeding occurred, the extremity on the side of the injury was systematically moved through flexion, extension, abduction and adduction sequentially 10 times or until rebleeding occurred. Results: There were significant differences in hemorrhage (P=.01), the amount of volume resuscitation (P =.01) and movement (P =.03) between the QCG and control groups. Conclusion: QCG is effective and statistically superior at controlling hemorrhage, allows for greater fluid resuscitation, and tolerates significant movement without rebleeding compared to the standard pressure dressing control in this hypothermic porcine model of uncontrolled hemorrhage.