Effectiveness of kaolin-impregnated hemostatic gauze use in preperitoneal pelvic packing for patients with pelvic fractures and hemodynamic instability: A propensity score matching analysis.

Kwangmin Kim,Seongyup Kim,Pil Young Jung,Jung Kuk Lee,Young Un Choi,Keum Seok Bae,Ji Young Jang,Hongjin Shim,Osama Farouk

doi:10.1371/journal.pone.0236645

Abstract

We evaluated the effectiveness of kaolin-impregnated hemostatic gauze use in preperitoneal pelvic packing (PPP) for patients with hemodynamic instability due to severe pelvic fractures. Between May 2014 and October 2018, 53 of 75 patients who underwent PPP due to hemodynamic instability induced by pelvic fracture were enrolled. Their medical records were prospectively collected and retrospectively analyzed. QuikClot combat gauze (hydrophilic gauze impregnated with kaolin) and general surgical tape were used in 21 patients, while general surgical tape was used in the remaining 32 patients. As there were differences in the characteristics of patients between the hemostatic gauze (HG) group and control group, propensity score matching (PSM) was performed to adjust for age, sex, and lactate levels. After PSM, the clinical characteristics between the two groups became similar. There were no differences in the rates of mortality and hemorrhage-induced mortality between the two groups. However, the packed red blood cell (RBC) requirement for an additional 12 hours in the HG group was significantly lower than that in the control group (4.1 ± 3.5 vs. 7.6 ± 6.1 units, p = 0.035). The lengths of intensive care unit and hospital stays tended to be shorter in the HG group than in the control group (11.6 vs. 18.5 days, p = 0.1582; 30.8 vs. 47.4 days, p = 0.1861, respectively). The use of HG during PPP did not reduce hemorrhage-induced mortality, but did reduce the need for additional packed RBC transfusions in patients with hemodynamic instability due to severe pelvic fractures.

Highlights

We evaluated the effectiveness of kaolin-impregnated hemostatic gauze use in preperitoneal pelvic packing (PPP) for patients with hemodynamic instability due to severe pelvic fractures
The lengths of intensive care unit and hospital stays tended to be shorter in the hemostatic gauze (HG) group than in the control group (11.6 vs. 18.5 days, p = 0.1582; 30.8 vs. 47.4 days, p = 0.1861, respectively)
Among commercially available hemostatic gauzes, QuikClot Combat Gauze (QCG; Z-Medica, Wallingford, CT, USA), a hydrophilic gauze impregnated with kaolin, enhances hemostasis by activating the intrinsic pathway

Summary

Introduction

We evaluated the effectiveness of kaolin-impregnated hemostatic gauze use in preperitoneal pelvic packing (PPP) for patients with hemodynamic instability due to severe pelvic fractures. Among commercially available hemostatic gauzes, QuikClot Combat Gauze (QCG; Z-Medica, Wallingford, CT, USA), a hydrophilic gauze impregnated with kaolin, enhances hemostasis by activating the intrinsic pathway. It was first used in trauma cases with hemorrhaging external wounds but has recently been used for patients with intracorporeal hemorrhage [9, 10]. The present study aimed to evaluate the effectiveness of kaolin-impregnated hemostatic gauze in PPP for patients with hemodynamic instability due to severe pelvic fractures A study using a hypothermic coagulopathic swine model showed that, compared to plain gauze, kaolin-impregnated gauze for packing in cases of high-grade liver injuries reduced postoperative hemorrhage [11].

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Results

Conclusion