The efficacy of Combat Gauze in extreme physiologic conditions

IntroductionCombat Gauze (CG) is currently the most widely used hemostatic dressing in combat. The testing of CG was initially performed in healthy and physiologically normal animals. The goal this study was to assess the efficacy in a model of severe acidosis and coagulopathy.MethodsTo obtain an acidotic and coagulopathic model, Yorkshire swine sustained 35% blood volume hemorrhage followed by a 50-min supraceliac aortic ischemia-reperfusion injury with 6-h resuscitation (epinephrine to keep mean arterial pressure >40 and intravenous fluids to keep central venous pressure >4). We created a femoral artery injury and randomized the animals to CG versus a standard gauze (SG) dressing. We performed rotational thromboelastography with both CG and SG.ResultsUsing our model, 17 anesthetized Yorkshire swine developed appropriately significant coagulopathy, acidosis, and anemia. The SG failure rate was 100% on the first application and worked once on the second application. Combat Gauze was successful in achieving hemostasis 93% of the time on the first application and had 100% success with the second application. Rotational thromboelastography demonstrated that the only difference was a decreased clotting time with CG compared with SG (P = 0.012).ConclusionsCombat Gauze significantly outperforms standard gauze dressings in a model of major vascular hemorrhage in acidotic and coagulopathic conditions. This effect appears to result from a decreased time lag between activation and first detectable clotting. Combat Gauze appears to maintain its efficacy even in the setting of severe acidosis and coagulopathy for the control of hemorrhage from vascular injury.