Journal article
Intra-abdominal packing with laparotomy pads and QuikClot™ during damage control laparotomy: A safety analysis
Injury, Vol.48(1), pp.158-164
01 Jan 2017
PMID: 27469399
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Intra-abdominal packing with laparotomy pads (LP) is a common and rapid method for hemorrhage control in critically injured patients. Combat Gauze™ and Trauma Pads™ ([QC] Z-Medica QuikClot®) are kaolin impregnated hemostatic agents, that in addition to LP, may improve hemorrhage control. While QC packing has been effective in a swine liver injury model, QC remains unstudied for human intra-abdominal use. We hypothesized QC packing during damage control laparotomy (DCL) better controls hemorrhage than standard packing and is safe for intracorporeal use.
A retrospective review (2011–2014) at a Level-I Trauma Center reviewed all patients who underwent DCL with intentionally retained packing. Clinical characteristics, intraoperative and postoperative parameters, and outcomes were compared with respect to packing (LP vs. LP+QC). All complications occurring within the patients’ hospital stays were reviewed. A p≤0.05 was considered significant.
68 patients underwent DCL with packing; (LP n=40; LP+QC n=28). No difference in age, BMI, injury mechanism, ISS, or GCS was detected (Table 1, all p>0.05). LP+QC patients had a lower systolic blood pressure upon ED presentation and greater blood loss during index laparotomy than LP patients. LP+QC patients received more packed red blood cell and fresh frozen plasma resuscitation during index laparotomy (both p<0.05). Despite greater physiologic derangement in the LP+QC group, there was no difference in total blood products required after index laparotomy until abdominal closure (LP vs LP+QC; p>0.05). After a median of 2days until abdominal closure in both groups, no difference in complications rates attributable to intra-abdominal packing (LP vs LP+QC) was detected.
While the addition of QC to LP packing did not confer additional benefit to standard packing, there was no additional morbidity identified with its use. The surgeons at our institution now select augmented packing with QC for sicker patients, as we believe this may have additional advantage over standard LP packing. A randomized controlled trial is warranted to further evaluate the intra-abdominal use of advanced hemostatic agents, like QC, for both hemostasis and associated morbidity.
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Details
- Title
- Intra-abdominal packing with laparotomy pads and QuikClot™ during damage control laparotomy: A safety analysis
- Creators
- Rachel L. Choron - Cooper University HospitalJoshua P. Hazelton - Cooper University HospitalKrystal Hunter - Cooper University HospitalLisa Capano-Wehrle - Cooper University HospitalJohn Gaughan - Cooper University HospitalJohn Chovanes - Cooper University HospitalMark J. Seamon - Hospital of the University of Pennsylvania
- Publication Details
- Injury, Vol.48(1), pp.158-164
- Publisher
- Elsevier Ltd
- Number of pages
- 7
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Surgery
- Web of Science ID
- WOS:000390544600028
- Scopus ID
- 2-s2.0-84979670958
- Other Identifier
- 991022056906604721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Critical Care Medicine
- Emergency Medicine
- Orthopedics
- Surgery