{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T15:29:36Z","timestamp":1771514976714,"version":"3.50.1"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"9-10","license":[{"start":{"date-parts":[[2025,3,29]],"date-time":"2025-03-29T00:00:00Z","timestamp":1743206400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/www.nationalarchives.gov.uk\/doc\/open-government-licence\/version\/3\/"}],"funder":[{"name":"by Canadian Forces Health Services, the CF Surgeon General\u2019s Health Research Program"},{"DOI":"10.13039\/100012114","name":"Defence Research and Development Canada","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012114","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000005","name":"the U.S. Department of Defense","doi-asserted-by":"crossref","award":["W81XWH2-020006 and HT942523C0095"],"award-info":[{"award-number":["W81XWH2-020006 and HT942523C0095"]}],"id":[{"id":"10.13039\/100000005","id-type":"DOI","asserted-by":"crossref"}]},{"name":"by Canadian Forces Health Services, the CF Surgeon General\u2019s Health Research Program"},{"DOI":"10.13039\/100012114","name":"Defence Research and Development Canada","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012114","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000005","name":"the U.S. Department of Defense","doi-asserted-by":"crossref","award":["W81XWH2-020006 and HT942523C0095"],"award-info":[{"award-number":["W81XWH2-020006 and HT942523C0095"]}],"id":[{"id":"10.13039\/100000005","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,9,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Trauma-induced hemorrhage is the leading cause of preventable death on the battlefield, with anatomical junctional wounds accounting for \u223c19% of deaths. This highlights the need for effective hemorrhage control interventions. Consequently, CounterFlow-Gauze was developed to deliver thrombin, tranexamic acid (TXA), and calcium through a self-propelling acid\u2013base reaction, eliminating the need for manual compression. This study evaluates the usability and efficacy of CounterFlow-Gauze to the Committee on Tactical Combat Casualty Care standard of care, Combat Gauze.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>Ten Canadian Armed Forces medics tested the usability CounterFlow-Gauze and Combat Gauze in a swine junctional hemorrhage model. A 4-mm vascular punch was used to induce femoral injury, followed by a 15-second free bleed. Medics packed the wound and applied 3-minute compression. Medics were blinded to the gauze treatment and completed surveys to evaluate the gauzes. Animals were observed for 3\u2009hours or until death, and blood loss was measured. Blood samples were also collected to measure TXA levels and establish baseline and treated values for blood gas, hematological, and coagulation parameters.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Medics reported enhanced usability and greater efficacy of CounterFlow-Gauze (4.3\u2009\u00b1\u20090.9\/5) compared to Combat Gauze (3.0\u2009\u00b1\u20091.2 \/5; P\u2009&amp;lt;\u2009.05) in attenuating bleeding. CounterFlow-Gauze achieved high survivability (10\/10 animals) and low blood loss (10.21\u2009\u00b1\u20091.83\u2009g\/kg) compared to Combat-Gauze (9\/10 animals, 12.72\u2009\u00b1\u20093.03\u2009g\/kg; P\u2009&amp;gt;\u2009.05), while delivering systemic therapeutic levels of TXA by 30\u2009minutes (10.92\u2009\u00b1\u20090.17\u2009\u00b5g\/mL). Changes in mean arterial pressure and heart rate were less pronounced with CounterFlow-Gauze compared to Combat Gauze (P\u2009&amp;gt;\u2009.05), while no differences were observed between baseline and treated values for any of the other measured parameters.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The self-propelling hemostatic agents of CounterFlow-Gauze may compensate for suboptimal packing by novice users or in high-stress situations. These findings support the adoption of CounterFlow-Gauze, providing all soldiers access to superior but restricted hemostatic agents in a safe and easy-to-use gauze on the battlefield.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usaf057","type":"journal-article","created":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T13:41:55Z","timestamp":1743428515000},"page":"e1929-e1936","source":"Crossref","is-referenced-by-count":1,"title":["CounterFlow Hemostatic Gauze Provides Military Medics Confidence and Demonstrates Effective Hemorrhage Control in a Live Tissue Simulation"],"prefix":"10.1093","volume":"190","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3017-3047","authenticated-orcid":false,"given":"Nabil","family":"Ali-Mohamad","sequence":"first","affiliation":[{"name":"Trauma and Acute Care Surgery, Faculty of Medicine, St. Michael\u2019s Hospital, University of Toronto , Toronto, ON M5B 1W8,","place":["Canada"]},{"name":"Michael Smith Laboratories, University of British Columbia , Vancouver, BC V6T 1Z4,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3303-5966","authenticated-orcid":false,"given":"Kanwal","family":"Singh","sequence":"additional","affiliation":[{"name":"Trauma and Acute Care Surgery, Faculty of Medicine, St. Michael\u2019s Hospital, University of Toronto , Toronto, ON M5B 1W8,","place":["Canada"]},{"name":"Defence Research and Development Canada, Toronto Research Centre , North York, ON M3K 2C9,","place":["Canada"]},{"name":"Canadian Forces Health Services , Ottawa, ON K1A 0K2,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8283-6650","authenticated-orcid":false,"given":"Massimo F","family":"Cau","sequence":"additional","affiliation":[{"name":"Michael Smith Laboratories, University of British Columbia , Vancouver, BC V6T 1Z4,","place":["Canada"]},{"name":"School of Biomedical Engineering, University of British Columbia , Vancouver, BC V6T 1Z4,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catherine","family":"Tenn","sequence":"additional","affiliation":[{"name":"Defence Research and Development Canada, Suffield Research Centre , Medicine Hat, AB T1A 8K6,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Danielle","family":"Bince","sequence":"additional","affiliation":[{"name":"Trauma and Acute Care Surgery, Faculty of Medicine, St. Michael\u2019s Hospital, University of Toronto , Toronto, ON M5B 1W8,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Colin","family":"Kamide","sequence":"additional","affiliation":[{"name":"Michael Smith Laboratories, University of British Columbia , Vancouver, BC V6T 1Z4,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5276-9573","authenticated-orcid":false,"given":"Henry","family":"Peng","sequence":"additional","affiliation":[{"name":"Defence Research and Development Canada, Toronto Research Centre , North York, ON M3K 2C9,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hugh","family":"Semple","sequence":"additional","affiliation":[{"name":"Defence Research and Development Canada, Suffield Research Centre , Medicine Hat, AB T1A 8K6,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3644-0019","authenticated-orcid":false,"given":"Christian J","family":"Kastrup","sequence":"additional","affiliation":[{"name":"Michael Smith Laboratories, University of British Columbia , Vancouver, BC V6T 1Z4,","place":["Canada"]},{"name":"School of Biomedical Engineering, University of British 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