# CELOX experience and comments?



## mycrofft (Mar 7, 2013)

Is it as good and as useful as it is represented to be?
How does it stack up against similar products?
How is it better, granules or gauze?
Do you think a person with basic first aid training and little experience could use it to advantage?


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## Veneficus (Mar 7, 2013)

works sometimes, overmarketed.


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## MrJones (Mar 7, 2013)

If you have access to CINAHL (or a similar database) there are a number of studies on the efficacy of Celox and other hemostatic agents. Here's one example from the "pro" camp

Kozen, B., Kircher, S., Henao, J., Godinez, F., & Johnson, A. (2008). An Alternative Hemostatic Dressing: Comparison of CELOX, HemCon, and QuikClot. Academic Emergency Medicine, 15(1), 74-81. 




> Abstract:
> OBJECTIVES: Uncontrolled hemorrhage remains a leading cause of traumatic death. Several topical adjunct agents have been shown to be effective in controlling hemorrhage, and two, chitosan wafer dressing (HemCon [HC]) and zeolite powder dressing (QuikClot [QC]), are being utilized regularly on the battlefield. However, recent literature reviews have concluded that no ideal topical agent exists. The authors compared a new chitosan granule dressing (CELOX [CX]) to HC, QC and standard dressing in a lethal hemorrhagic groin injury. METHODS: A complex groin injury with transection of the femoral vessels and 3 minutes of uncontrolled hemorrhage was created in 48 swine. The animals were then randomized to four treatment groups (12 animals each). Group 1 included standard gauze dressing (SD); Group 2, CX; Group 3, HC; and Group 4, QC. Each agent was applied with 5 minutes of manual pressure followed by a standard field compression dressing. Hetastarch (500 mL) was infused over 30 minutes. Hemodynamic parameters were recorded over 180 minutes. Primary endpoints included rebleed and death. RESULTS: CX reduced rebleeding to 0% (p < 0.001), HC to 33% (95% CI = 19.7% to 46.3%, p = 0.038), and QC to 8% (95% CI = 3.3% to 15.7%, p = 0.001), compared to 83% (95% CI = 72.4% to 93.6%) for SD. CX improved survival to 100% compared to SD at 50% (95% CI = 35.9% to 64.2%, p = 0.018). Survival for HC (67%) (95% CI = 53.7% to 80.3%) and QC (92%; 95% CI = 84.3% to 99.7%) did not differ from SD. CONCLUSIONS: In this porcine model of uncontrolled hemorrhage, CX improved hemorrhage control and survival. CELOX is a viable alternative for the treatment of severe hemorrhage.



And one from the "con" camp

Watters, J., Van, P., Hamilton, G., Sambasivan, C., Differding, J., & Schreiber, M. (2011). Advanced hemostatic dressings are not superior to gauze for care under fire scenarios. Journal Of Trauma, 70(6), 1413-1419. doi:http://dx.doi.org.libproxy.eku.edu/10.1097/TA.0b013e318216b796



> ABSTRACT:
> BACKGROUND: : Advanced hemostatic dressings perform superior to standard gauze (SG) in animal hemorrhage models but require 2 minutes to 5 minutes application time, which is not feasible on the battlefield. METHODS: : Twenty-four swine received a femoral artery injury, 30 seconds uncontrolled hemorrhage and randomization to packing with SG, Combat Gauze (CG), or Celox Gauze (XG) without external pressure. Animals were resuscitated to baseline mean arterial pressures with lactated Ringers and monitored for 120 minutes. Physiologic and coagulation parameters were collected throughout. Dressing failure was defined as overt bleeding outside the wound cavity. Tissues were collected for histologic and ultrastructural studies. RESULTS: : All animals survived to study end. There were no differences in baseline physiologic or coagulation parameters or in dressing success rate (SG: 8/8, CG: 4/8, XG: 6/8) or blood loss between groups (SG: 260 mL, CG: 374 mL, XG: 204 mL; p > 0.3). SG (40 seconds ± 0.9 seconds) packed significantly faster than either the CG (52 ± 2.0) or XG (59 ± 1.9). At 120 minutes, all groups had a significantly shorter time to clot formation compared with baseline (p < 0.01). At 30 minutes, the XG animals had shorter time to clot compared with SG and CG animals (p < 0.05). All histology sections had mild intimal and medial edema. No inflammation, necrosis, or deposition of dressing particles in vessel walls was observed. No histologic or ultrastructural differences were found between the study dressings. CONCLUSIONS: : Advanced hemostatic dressings do not perform better than conventional gauze in an injury and application model similar to a care under fire scenario.



Take your pick. 

ETA: Keeping those studies in mind, my experience is that Celox works well, is not much different (in application and effectiveness) from other readily available hemostatics, the gauze is preferable to the granules, and someone with basic 1st Aid training can be trained to use it effectively.


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## mycrofft (Mar 7, 2013)

Thanks all. I'm looking for anecdotal, preferably first person experiences. 
The manufacturer says clear out the excess blood, find the bleeder, then either pour the granules in or intimately stuff in the gauze and hold pressure for bleeders. That is NOT basic first aid.


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## MrJones (Mar 7, 2013)

mycrofft said:


> Thanks all. I'm looking for anecdotal, preferably first person experiences.
> The manufacturer says clear out the excess blood, find the bleeder, then either pour the granules in or intimately stuff in the gauze and hold pressure for bleeders. That is NOT basic first aid.



You're right, it's not. But you didn't ask if it _is_ basic first aid: You asked if someone "...with basic first aid training and little experience could use it to advantage" and I believe that they could indeed use the gauze to advantage.


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## mycrofft (Mar 7, 2013)

OK.
Have you?


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## MrJones (Mar 8, 2013)

mycrofft said:


> OK.
> Have you?



To expand on what I stated earlier, my experience is that Celox works well when used in conjunction w/ direct pressure (as does Quickclot) and I personally prefer the gauze over the granules. My subjective opinion is that the bleeding is controlled faster than it is with traditional methods. But, as I pointed out earlier, there are controlled studies that provide proof that it does work better than traditional methods and that it doesn't work better traditional methods. In other words, YMMV, but that's my anecdotal first person input.


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## BSE (Mar 8, 2013)

Used it once in the field.  It was the older tube injection style.  Easy to apply if you have a good tract to follow, which I did in this case.  It was an upper thigh (groin) wound....couldn't get the tourniquet high enough to be effective.  I "think" it worked....it was that or the ton of pressure I held, hard to tell.  I held the pressure with my knee (with a mountain of gauze for padding and displacement) during the flight so my hands were free. 

I say I "think" it worked because I really don't know if regular gauze packing would have been better or worse.  I've used good old fashioned cling with similar results.

Surgeons hate it...but I think that's because they don't like to clean it up.

Sorry, not the definitive answer you were looking for.


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## mycrofft (Mar 8, 2013)

NO perfect. Thanks MrJones and BSE


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## MrJones (Mar 8, 2013)

I'll add one more thought. Accepting that the jury's out on the effectiveness of hemostatic agents, and since the latest impregnated-gauze versions don't cause the problems that the older, granular formulations did, I'm firmly in the "it can't hurt and it just might help" camp. 

In other words (and I know that there are one or two here who will disagree with this POV, but them's the breaks), if there's a chance that using celox will help control bleeding more quickly than not using it, and it's use won't harm the patient, I see no reason to not use it.


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## Veneficus (Mar 8, 2013)

*Confucius say...*

"Do not use a cannon to kill a mosquito"


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## Summit (Mar 8, 2013)

Veneficus said:


> "Do not use a cannon to kill a mosquito"



Some mosquitoes require surface to air missiles.


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