Impact of Extreme Temperatures on Hemostatic Gauze Using Thromboelastography

IntroductionHemorrhage control in austere environments is challenging, particularly for wounds that are not amenable to tourniquets. Hemostatic gauzes are crucial in such settings, but their efficacy may be compromised by suboptimal storage conditions, including extreme temperatures, where discoloration has been observed. This study evaluated the impact of extreme temperature exposure on the efficacy of hemostatic gauze using thromboelastography.MethodsBlood from 30 healthy adults was diluted by 30% with hetastarch to mimic trauma-induced coagulopathy. Kerlix and QuikClot Combat Gauze stored for 3 weeks in cold (-10°C), hot (70°C), and room-temperature (22°C) environments were compared in the thromboelastography parameters of <i>R</i> (time to initiation of clot formation), <i>K</i> (clot amplification), <i>α</i> angle (clot formation rate), and <i>MA</i> (maximum amplitude of clot).ResultsCompared with whole blood, diluted blood had weaker clots with slower clot-formation kinetics (<i>MA</i>=58 vs 43 mm, <i>P</i><0.0001; <i>K</i>=2.6 vs 4.0 min, <i>P</i><0.0001; <i>α</i> angle=55 vs 47 degrees, <i>P</i><0.0003) but faster clot initiation times (<i>R</i>=8.7 vs 7.1 min, <i>P</i><0.0001). Addition of either gauze shortened clot initiation times (Kerlix: 7.1 vs 5.0 min, <i>P</i><0.0001; QuikClot Combat Gauze: 7.1 vs 2.7 min, <i>P</i><0.0001), with QuikClot Combat Gauze significantly shortening <i>R</i> compared with Kerlix. Reductions in <i>R</i> values were consistent across temperature extremes (<i>P</i><0.05). The other parameters were consistently unaffected (<i>P</i>>0.05).ConclusionsThis in vitro laboratory study demonstrated that hemostatic gauze retained its ability to initiate clotting in vitro even after prolonged exposure to temperature extremes.