[uberuberuber]

I am a former critical care medic, and lack the scientific training to judge the merits of their claims about mechanism of action, but if history is any guide regarding ‘miracle’ products it will not live up to the manufacturers claims.

The use cases I can think of and commentary:

-Hemostasis after non-emergent ear/nose/throat procedures. -Packing of the wound + local epinephrine administration is currently used. It costs nothing, is well understood, and doesn’t have the potential for embolization or immune system interaction weirdness.

-Hemostasis of an extremity wound AFTER a tourniquet has been applied. -After a tourniquet is properly placed, the arterial flow is halted. Trauma teams have learned from military and orthopedic surgeons that tourniquets are much safer than traditionally understood. Even an amputated limb has a warm ischemia team of 6 hours. The addition of a clotting agent would stop venous oozing, but wouldn’t affect hemodynamics of the patient. It might assist in the case of an inappropriately applied tourniquet.

-Hemostasis of an abdominal wound. - I guess they envisage pouring this material into the abdomen? That seems like the place most fraught with danger of embolization distally to the mesentery and the generation of immune system interaction weirdness beyond my knowledge base.

A kaolin-based product (Quickclot) was similarly marketed as a wonder drug for treating massive hemorrhage on the battlefield, and it has been less than wonderful in practice. There are youtube videos attesting to its efficacy on the femoral arteries of swine, however these videos ignore the effect wind has upon the powder in a combat setting, and the exothermic reaction that takes place to create the plug. The only way to stop a large hemorrhage is to use copious amounts of the material, resulting in severe burns in some case reports. Concern over embolization of the clotted material led them to create a gauze-bag version.

The company’s claims that holding pressure over the wound is not required runs counter to basic trauma care recommendations. The single best way to halt life-threatening hemorrhage in an extremity is a tourniquet, and the only thing that halts thorax hemorrhage is a surgeon’s finger. The inclusion of this gel in the treatment algorithm would need to be as a last resort, and must never distract from the basics of direct pressure and rapid transport to a surgeon.

I don't know if this qualifies as an ad hominem on my part, but the article comes across as written by the journalist in close coordination with the companies PR firm. The 'hook' inherent in the choice of headline combined with the lack of any discussion of the limitations of the product or previous failures with regards to ‘miracle’ hemorrhage agents cements this in my opinion.

[JumpCrisscross]

OP (edit: submitter) has zero comment history and appears to have only submitted his own articles [1]. Not damning, but a red flag.

[1] https://news.ycombinator.com/submitted?id=leojkent

[justin66]

We all had a story or something that motivated us to register and comment.

I've heard everything he's said before from other people in trauma medicine. (but there are also people who will stick up for the Quickclot type stuff!) It's not my field and I'm not in a position to judge. I will say that I share his view that the article reads like something written by a PR flack.

[DigitalJack]

I believe he was referring to the submitter.

[justin66]

Thank you. My mistake.

[readme]

So what? There's no rule that says you have to comment. There's no rule that I know of against submitting your own stuff.

If you're writing quality articles (which this is) and submitting OC, then that's a good thing.

[healthenclave]

Well it seems that this gel might have very little application on it's own and would be best used in conjunction with traditional tried and tested methods.

The major flaw with this gel is the risk of Hematoma. Basically lets say you have a vessel that has been ruptured by trauma and you use this gel to pack up the external wound.

But the vessel is still leaky !! This will lead to collection of blood inside the body and can be harmful in the long run.

It seems this gel is most suited for (their first clients) the military. And would be effective on the field along with using tourniquet.

Also there is already a variety of Surgical Glue that is in use. But it's used along with traditional sutures as the glue is not strong enough and will rupture. So on the fragile inner layers we use the glue and then towards the skin which is much more stronger the usual catgut sutures are used.

[kkwok]

Since you clearly know a lot on this subject, what are your thoughts on this related Darpa funded project: http://www.healthline.com/health-news/darpa-wound-stasis-foa...

[uberuberuber]

I'd like to again qualify my status as a non-expert with regards to the surgical aspects of trauma treatment and biochemistry. I have seen similar articles about the foam, and I must admit I am similarly skeptical. The ‘Golden Hour’ is one of those concepts in medicine that everyone praises (it originated @ Marylan’s Shock Trauma center if I recall), but it actually does not have an evidentiary basis.

There are 3 categories of trauma patient, people who will die no matter what you do (hole in the aorta), people who will live no matter what you do (fractured extremities), and people where the outcome may be influenced by treatment in the field. My non-evidence based opinion is that the people in this 3rd population who have the types of injuries that would benefit from this foam will be rather limited. The aorta, inferior vena cava, kidneys and parts of the duodenum, pancreas and rectum are all retroperitoneal. Thus, filling the peritoneal cavity with foam could put pressure on bleeding structures located in the retroperitoneal space, but I would be skeptical. So this foam is for people who have don’t have large hemorrhage of anything in retroperitoneal space and don’t have a fatal mesenteric, liver, or spleen injury, but do have an injury to one of these structures that is sufficiently bad to warrant the foam. The risk of exposing patients with liver and spleen lacerations that could have been managed non-operatively (again, not a surgeon by any stretch but I believe this is a growing trend) to an unnecessary laparotomy isn’t mentioned.

The target audience for this item is going to be armed forces medics with (in my opinion) highly variable clinical skills. Expecting these medics to accurately diagnosis these injuries under heavy stress and not sacrifice time that should be spent on proven therapies like blood administration, tourniquet placement, warm blankets, etc. seems unwise to me.

[kkwok]

Thanks so much for responding. My worry when reading articles like these is that I know I don't have the background to evaluate the technology, but I don't often know where to go to find people who do.

This was a really useful perspective to hear.