Polyphosphate-based hemostatic gauze preserves distal perfusion compared with QuikClot Combat Gauze in a porcine extremity trauma model with hemorrhagic shock.

Abstract

Uncontrolled hemorrhage remains the leading preventable cause of death after trauma. Current prehospital strategies emphasize rapid bleeding control, yet benchmark kaolin-based dressings may impair distal perfusion through intraluminal thrombosis. Polyphosphate (PolyP)-based dressings could offer effective hemostasis while maintaining arterial flow. In a prospective, randomized, controlled large-animal extremity trauma model with hemorrhagic shock, PolyP gauze was compared with kaolin-based Combat Gauze (CG) under a standardized compression and resuscitation protocol. Primary endpoints were survival time and survival proportion; secondary endpoints included distal femoral flow, blood loss, hemodynamics, metabolic status, and coagulation. Outcome assessment was investigator blinded. Baseline characteristics were comparable between groups (n = 11 per group). Survival at 120 minutes (PolyP 90.9% vs. CG 81.8%) and total blood loss (1,780 ± 219 vs. 1,847 ± 484 mL, p = 0.72) did not differ significantly. First-pass hemostasis was achieved in 63.6% of PolyP- and 81.8% of CG-treated animals (p = 0.64). In contrast, distal pulsatile femoral flow was restored in 90.9% of PolyP-treated animals compared with 27.3% after CG (p = 0.0075). Hemodynamics, metabolic markers (lactate, base excess, pH, hemoglobin), and systemic coagulation assays (prothrombin time, fibrinogen, activated partial thromboplastin time) evolved similarly across groups. In this swine extremity trauma model with shock, PolyP gauze provided hemostasis equivalent to the current benchmark while significantly improving distal arterial perfusion. These findings support expanding performance benchmarks for prehospital hemostatic dressings to include downstream perfusion and justify further translational and field evaluation. (J Trauma Acute Care Surg. 2026;101: 129-135. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.).