Hemostatic agents for prehospital hemorrhage control: a narrative review

Table 1 Potential hemostatic agents for prehospital and combat hemorrhage control

Typical hemostats	Bleeding sites	Comments
Intravenous infusion
Coagulation factor concentrates: fibrinogen, recombinant factor VII, prothrombin complex [33,34,35,36]	Extremity/junctional/truncal hemorrhage	Used clinically and in remote operational environments, showing logistic benefits, requiring more randomized controlled trials for clinical benefits
Dried plasma [37, 38]	Extremity/junctional/truncal hemorrhage	Used prehospitally and on the battlefield, showing logistic benefits and a positive effect on coagulation profile, with no effects on other outcomes
Tranexamic acid [39,40,41,42]	Extremity/junctional/truncal hemorrhage	Used prehospitally and on the battlefield, suggesting a survival advantage to severely bleeding patients
Dried platelets [43,44,45]	Extremity/junctional/truncal hemorrhage	Under development
Platelet substitutes/synthetic platelets [46,47,48]	Extremity/junctional/truncal hemorrhage	Under development
Synthetic polymers: polySTAT [49,50,51]	Extremity/junctional/truncal hemorrhage	Under development, improved survival compared to an albumin control in a rat femoral artery injury
Local application
Hemostatic dressings: Combat Gauze, Celox Gauze, ChitoGauze, HemCon dressing [52,53,54]	Extremity/junctional hemorrhage	Used on the battlefield and in prehospital settings
Injectable and self-expanding sponges (XStat), intracavitary forms (ResQFoam, ClotFoam), in situ forming gels, self-propelling particles [19, 25, 27, 55, 56]	Truncal hemorrhage	Under development

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