Hemostatic dressings reduce tourniquet time while maintaining hemorrhage control

Tourniquet application has become first-line treatment for extremity hemorrhage on the battlefield and has seen increased use in the civilian arena. We hypothesized that an effective windlass tourniquet could be removed after application of a hemostatic dressing in a swine model of peripheral vascular injury. A tourniquet was placed proximally in 50 forelimb-injured swine after 30 seconds of hemorrhage with cessation of hemorrhage in all cases. Hemcon, ActCel, Quikclot, Celox, or standard gauze was then placed over the wound with direct pressure for three minutes. The tourniquet was then removed. Success was determined if no bleeding was identified. Standard gauze resulted in a 100 per cent failure rate with active bleeding present after each application. Celox was successful in maintaining hemostasis in 6 of 10 (60%) subjects. Quikclot succeeded in 80 per cent of subjects. ActCel maintained hemostasis in nine (90%) subjects, whereas HemCon was successful in all instances (100%). All four hemostatic dressings were superior to gauze in maintaining hemostasis after removal of an effective tourniquet. Use of hemostatic dressings in conjunction with a tourniquet may reduce tourniquet times and improve outcomes in peripheral vascular injury and warrants further study.