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Below you will find the most recent TCCC updates. All attachments have been converted to links. The links are:

TCCC Guidelines- November 2015

XSTAT Training Slides

Proposed TCCC Changes- XSTAT, November 2015

Craig K. Hall, TP-C

Director of Training

Cell: 267-979-3161

Office: 215-657-1909

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Addition of XStat to the TCCC Guidelines

From: Frank Butler

Sent: Thursday, January 21, 2016 10:09 AM


A novel hemostatic product called XStat™ has recentlybeen developed by RevMedx in Wilsonville, OR. The XStat™ system consists of approximately92 flat, circular, compressed mini sponges that are coated with the hemostaticsubstance chitosan and packaged in a 60cc syringe applicator. The unexpandedmini sponges are 9 mm in diameter and 4.5 mm in height.  When injected into a wound cavity, the spongesexpand when they come into contact with blood, filling the wound cavity and exertingpressure on bleeding vessels from within the wound cavity.


XStat was evaluated in an animal model of severe bleedingat the Naval Medical Research Unit – San Antonio in 2013. Cestero and hiscolleagues compared XStat TM to Combat Gauze™ in a porcine model of subclavian arteryand vein transection similar to that used in a previous study by Mueller, etal. XStat™ was found to require significantly less time (31 seconds vs 65seconds) to pack in to the wound and to significantly reduce the amount ofblood lost during application (1.3 g/kg vs 5.1 g/kg) without requiring manualcompression by the provider after application into the wound. No significant differenceswere found with respect to either survival or post-treatment blood loss. Incontrast to the Mueller study, all animals in both the XStat™ and the Combat Gauze™arms of the study survived.


A proposed change to the TCCC Guidelines to add XStat™ asa hemostatic adjunct was recently reviewed by the TCCC Working Group and approvedby the required 2/3 or more of the voting members of the CoTCCC. XStat™ may beparticularly useful in junctional wounds in the groin or axilla in which the bleedingcomes from a wound with a deep, narrow wound track.


The position paper for this change tothe TCCC Guidelineshas been finalized and approved for publication by the US Army Institute of SurgicalResearch.  The attached version of thepaper has been submitted to the Journal of Special Operaions Medicine and willbe published in that journal in the near future.


The training slides to support this change to the TCCCGuidelines have been developed by Dr. Stephen Giebner, the CoTCCC DevelopmentalEditor and are attached. These XStat slides will be incorporated into the 2016 versionof the TCCC for Medical Personnel curriculum, which will come out thissummer.  If there are any proposedchanges to TCCC curriculum materials, please forward these to Dr. Giebner ( as soon as possible.


The updated TCCC Guidelines, dated 151111, are alsoattached.


THANKS to SGM Kyle Sims, SGM F Bowling, MSG (Ret) ³Monty²Montgomery, SFC Paul Dituro, and Dr. Bijan Kheirabadi for their outstandingwork in developing this update to the TCCC Guidelines.


V/R -




Frank K. Butler, MD

CAPT   MC  USN (Ret)