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CounterFlow Hemostatic Gauze Provides Military Medics Confidence and Demonstrates Effective Hemorrhage Control in a
Nabil Ali-Mohamad1,2, Kanwal Singh1,3,4, Massimo F Cau2,5
1Trauma and Acute Care Surgery, Faculty of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON M5B 1W8, Canada.
Introduction:
Trauma-induced hemorrhage is the leading cause of preventable death on the battlefield, with anatomical junctional wounds accounting for ∼19% of deaths. This highlights the need for effective hemorrhage control interventions. Consequently, CounterFlow-Gauze was developed to deliver thrombin, tranexamic acid (TXA), and calcium through a self-propelling acid-base reaction, eliminating the need for manual compression. This study evaluates the usability and efficacy of CounterFlow-Gauze to the Committee on Tactical Combat Casualty Care standard of care, Combat Gauze.
Materials And Methods:
Ten Canadian Armed Forces medics tested the usability CounterFlow-Gauze and Combat Gauze in a swine junctional hemorrhage model. A 4-mm vascular punch was used to induce femoral injury, followed by a 15-second free bleed. Medics packed the wound and applied 3-minute compression. Medics were blinded to the gauze treatment and completed surveys to evaluate the gauzes. Animals were observed for 3 hours or until death, and blood loss was measured. Blood samples were also collected to measure TXA levels and establish baseline and treated values for blood gas, hematological, and coagulation parameters.
Results:
Medics reported enhanced usability and greater efficacy of CounterFlow-Gauze (4.3 ± 0.9/5) compared to Combat Gauze (3.0 ± 1.2 /5; P < .05) in attenuating bleeding. CounterFlow-Gauze achieved high survivability (10/10 animals) and low blood loss (10.21 ± 1.83 g/kg) compared to Combat-Gauze (9/10 animals, 12.72 ± 3.03 g/kg; P > .05), while delivering systemic therapeutic levels of TXA by 30 minutes (10.92 ± 0.17 µg/mL). Changes in mean arterial pressure and heart rate were less pronounced with CounterFlow-Gauze compared to Combat Gauze (P > .05), while no differences were observed between baseline and treated values for any of the other measured parameters.
Conclusions:
The self-propelling hemostatic agents of CounterFlow-Gauze may compensate for suboptimal packing by novice users or in high-stress situations. These findings support the adoption of CounterFlow-Gauze, providing all soldiers access to superior but restricted hemostatic agents in a safe and easy-to-use gauze on the battlefield.
