Comparative efficacy of new-generation hemostatic dressings in the treatment of arterial injuries in prehospital conditions

Uncontrolled hemorrhage represents the leading cause of preventable death in traumatic injuries, with arterial injuries requiring urgent and effective intervention in prehospital conditions. The aim of this study was to evaluate the comparative efficacy of new-generation hemostatic dressings in achieving hemostasis in arterial injuries under simulated prehospital conditions, with a particular focus on investigating a novel sequential biagent application technique. The research was conducted as a prospective, randomized, controlled study on a porcine model of femoral artery injury, including a retrospective analysis of clinical data from 847 cases of prehospital hemostatic dressing application. Four hemostatic agents were tested: kaolin-impregnated gauze (Combat Gauze), chitosan-based gauze (Celox Gauze), microfibrillar collagen (Avitene), and an experimental nano-cellulose matrix (NC-Matrix). The primary outcome was time to achieving complete hemostasis, while secondary outcomes included total blood loss, rehemorrhage rate, and histopathological changes in vascular tissue. Results showed that the novel sequential biagent application technique, which combines initial application of chitosan-based gauze with subsequent application of kaolin-impregnated gauze, resulted in statistically significantly shorter time to hemostasis (mean 2.3 ± 0.7 minutes) compared to standard monotherapy with any single agent (3.4 ± 1.1 minutes for Combat Gauze; 3.8 ± 1.3 minutes for Celox Gauze; p < 0.001). Additionally, the combined technique showed a 31.4% reduction in total blood loss compared to the best single agent. Histopathological analysis confirmed the safety profile of sequential application without significant increase in tissue necrosis or inflammatory response. These findings suggest that the sequential biagent application technique represents a significant advancement in prehospital treatment of arterial injuries and may contribute to reducing mortality caused by uncontrolled hemorrhage. Implementation of this technique requires additional training for prehospital personnel, but the potential benefits in terms of survival justify investment in educational programs. Future research should include multicenter clinical studies in human populations to confirm the applicability of these results in real clinical conditions.