Grotenhuis, R., et al. Injury, Int. J. Care Injured 47 (2016) 1007–1011.
This is the largest prospective study in civilian healthcare and the second largest case series with prehospital use of hemostatic dressings. Over 2.5 years all ambulances of two emergency medical services in the Netherlands were equipped with ChitoGauze, total of 66 cases were reported on. It demonstrated that ChitoGauze is an effective and safe adjunct in the prehospital treatment of massive external traumatic hemorrhage. ChitoGauze resulted in cessation or reduction of hemorrhage in the majority of all patients.
Study Inclusion criteria
Massive traumatic hemorrhage with one of the following:
- Failure of conventional treatment to control hemorrhage within 5 min
- Hemorrhage unlikely to be controlled with standard treatment (penetrating injury, difficult to reach with dressing, large laceration or amputation)
- Life-threatening hemorrhage
Study Exclusion Criteria:
- Non-traumatic hemorrhage
In this study, ChitoGauze completely stopped haemorrhage in 70% (95% CI 59–81%) and reduced haemorrhage in 20% (95% CI 10–30%) of the patients. No side effects have been reported. The dressing scored high on user-friendliness. The ambulance personnel estimated that ChitoGauze had been more effective than conventional treatment would have been and were satisfied with the result in the majority of the cases. The dressing failed to control hemorrhage in 11% (95% CI 3–19%) of the patients. Analysis of these cases demonstrated that user error was a significant contributing factor in some of these failures as the dressing was not applied deep enough into the wound. Subgroup analysis indicated that the effect of ChitoGauze may be affected by the type and location of hemorrhage.