Is QuickClot (zeolite hemostatic agent) still used in medical practice?

Is QuikClot Still Used in Medical Practice?

Yes, QuikClot Combat Gauze (the kaolin-based version) remains in active use, particularly in military and prehospital settings, though the original zeolite-based QuikClot has been largely replaced due to safety concerns. The evolution from zeolite to kaolin-based formulations has addressed the major complications while maintaining hemostatic efficacy.

Evolution of QuikClot Technology

The original zeolite-based QuikClot granules caused significant complications:

• Generated extreme exothermic reactions with peak temperatures reaching 93.3°C at the tissue interface 1
• Caused burns requiring skin grafting in documented cases 2
• Produced foreign body reactions and scar formation when used intracorporeally 2
• Despite these issues, achieved 92% efficacy in controlling hemorrhage in 103 documented military and civilian uses 2

The newer QuikClot Combat Gauze (kaolin-based, impregnated into gauze) has replaced the granular zeolite formulation and demonstrates improved safety:

• No exothermic reactions or burns reported in clinical use 3, 4
• 79-93% success rate in controlling hemorrhage 3, 4
• No adverse events or complications documented in field applications 4

Current Clinical Applications

Military Use

QuikClot Combat Gauze is recommended as a first-line hemostatic agent by the U.S. military for severe hemorrhage 5. During the 2009 Gaza Strip operations, Israeli Defense Forces reported:

• 14 documented uses with 79% success rate 4
• Applied to head, neck, axilla, buttocks, abdomen, back, pelvis, and extremities 4
• Failures attributed to severe vascular injuries, not product ineffectiveness 4

Civilian Prehospital Use

In civilian emergency medical services, QuikClot Combat Gauze serves as an adjunctive tool:

• 30 prospective uses showed 73% complete bleeding cessation (22/30 cases) 3
• Primarily used for cervicocephalic wounds and active arterial bleeding 3
• Justified when standard hemostasis techniques (direct pressure, tourniquets) failed 3
• Enabled tourniquet removal in 3 cases after successful application 3

Guideline Recommendations for Hemostatic Dressings

The 2015 International Consensus on First Aid recommends hemostatic dressings when standard hemorrhage control (direct pressure with or without gauze) cannot control severe external bleeding 6. Key points:

• Hemostatic dressings achieve hemostasis in 90.8% of cases 6
• 73% achieve bleeding cessation in under 3 minutes 6
• Complications occur in only 3% of cases 6
• Most useful for severe bleeding where tourniquets cannot be applied or are unavailable 6

Specific Indications from Guidelines

European trauma guidelines classify hemostatic agents by mechanism 6:

• Mineral-based (zeolite/smectite): Used mainly for external bleeding in prehospital settings 6
• Polysaccharide-based: Effective for external use and splanchnic bleeding 6
• Chitosan-based (like Axiostat): Recommended for venous and moderate arterial bleeding when access is difficult 7

Clinical Algorithm for Use

When to use hemostatic dressings:

1. First-line interventions fail: Apply when direct manual pressure for 5-10 minutes does not achieve hemostasis 8
2. Anatomic limitations: Use when tourniquets cannot be applied (junctional wounds, neck, axilla, groin) 6, 3
3. Severe arterial bleeding: Particularly effective for active arterial hemorrhage in compressible locations 3

Application technique:

• Pack directly into the wound at the source of bleeding 3
• Maintain firm pressure for minimum 3 minutes 6
• Do not repeatedly lift to check—this disrupts clot formation 8

Important Caveats and Limitations

When Hemostatic Dressings May Fail

• Coagulopathic patients: Massive resuscitation-induced coagulopathy reduces effectiveness 2
• Inaccessible bleeding sources: Cannot reach the actual hemorrhage site 2
• Severe vascular injuries: Major vessel disruption may overwhelm hemostatic capacity 4

Safety Considerations

• Modern kaolin-based formulations (QuikClot Combat Gauze) do not cause burns or exothermic reactions 3, 4
• Avoid intracorporeal use of any granular formulations due to foreign body reaction risk 2
• Training in proper application technique is essential for effectiveness 6

Comparison to Other Hemostatic Options

Collagen-based agents: Trigger platelet aggregation, often combined with thrombin 6, 9

Gelatin-based products: Swell to reduce blood flow, can be combined with thrombin 6, 9

Chitosan-based (Axiostat): Particularly useful for difficult-to-access bleeding sites 7, 9

QuikClot Combat Gauze advantages: Combines ease of application with proven field efficacy, no exothermic reaction, and established military/civilian track record 5, 3, 4

Bottom Line for Practice

QuikClot Combat Gauze remains a valuable hemostatic tool in 2024, particularly for prehospital providers managing severe external hemorrhage that fails standard control measures. The transition from zeolite granules to kaolin-impregnated gauze has eliminated the burn risk while maintaining hemostatic efficacy. It should be applied with firm, sustained pressure directly to the bleeding source for at least 3 minutes, and is most effective in non-coagulopathic patients with compressible hemorrhage 6, 3, 4.