We’ve all heard the saying, “All bleeding stops eventually,” right? Wouldn’t it be nice if we had something to help stop the bleeding before exsanguination takes care of the problem for us? Direct pressure was the mantra for bleeding control for centuries, and short of a tourniquet there have been no real improvements to this method until just a few years ago. Along came powders and gauze impregnated with hemostatic agents.
EPM puts Z-Medica’s QuikClot to the test in a busy St. Louis ED
We’ve all heard the saying, “All bleeding stops eventually,” right? Wouldn’t it be nice if we had something to help stop the bleeding before exsanguination takes care of the problem for us? Direct pressure was the mantra for bleeding control for centuries, and short of a tourniquet there have been no real improvements to this method until just a few years ago. Along came powders and gauze impregnated with hemostatic agents. The big drawback to these initial products was the exothermic reaction created by their interaction with blood adding some increased discomfort to what you can already imagine was an uncomfortable injury. This month we are talking about one of the latest generation of hemostatic agents; QuikClot from Z-Medica Corporation.
QuikClot (forget the “c” because they don’t need it) has been in the anticoagulation game since 2002. QuikClot works via a mineral found naturally called Zeolite. Zeolite has several properties that make it a superb agent for coagulation. First, surface area. Per the QuikClot web site, one teaspoon of Zeolite has the equivalent surface area of a football field. Secondly, zeolite activates platelets helping to potentiate their clot-forming ability. The zeolite in QuikClot contains Ca++ which acts as a cofactor in the coagulation cascade, and finally zeolite absorbs water, which in turn concentrates the blood assisting in coagulation.
Oddly enough, it’s this reaction that causes the excessive heat created by first generation hemostatic agents. QuikClot attenuates this by controlling the moisture content of its gauze which in turn controls how aggressively the water in blood reacts with zeolite. While formulating this for their latest generation of products, they had to find the sweet spot between effectiveness and heat production. Z-Medica seems to think they found this.
Now let’s get down to brass tacks here. How does the product work? Over the course of several weeks I used the entire family of QuikClot medical products ranging from 2×2’s and 4×4’s to their new trauma pads. I used them on everything from small venous oozers all the way up to moderate arterial bleeds (nothing larger than popliteal bleeds). I didn’t have the opportunity to do any side-by-side comparisons with, say, bilateral GSWs to the extremities where I could directly compare effectiveness on the same patient. Instead, I had to use previous experience to gauge effectiveness. QuikClot did great with all venous injuries, stopping all but the most aggressive oozers with a simple pressure dressing. More aggressive venous injuries stopped with the addition of some direct pressure. When pitted against arterial injuries QuickClot had a little more difficulty. Much like the aforementioned aggressive venous bleeds, QuickClot easily handled small arteriolar bleeds as long as you applied direct pressure for several minutes. The only place where I saw QuikClot really stumble was with moderate to large vessel arterial bleeds. I had a few occasions to use it with GSWs below the knee with large tissue defects. In these injuries the QuikClot was only effective when used in conjunction with direct pressure. As you would expect with any dressing, when pressure was released the bleeding restarted. On these larger injuries QuikClot performed on par with standard dressings. Of note, all of the injuries in which QuickClot could not achieve hemostasis ended up in the OR for definitive repair.
So where do I stand on QuikClot? As a military doctor I see the benefits of hemostatic dressings when working overseas. In my ED in St. Louis, I see its benefits on a daily basis. It does a great job with all but the most aggressive hemorrhages; and it’s likely that only a surgeon is going to stop that bleeding anyway.
2001 – Z-Medica’s QuikClot is partially inspired by a scene in Black Hawk Down in which a soldier bleeds to death.
2007 – Mark Wahlberg puts QuikClot front and center in the movie Shooter when he uses it to stop the bleeding from two gunshot wounds.
2009 – QuikClot joins Tom Hanks in Columbia Pictures’ Angels and Demons.