BACKGROUND: Hemostatic powders offer unique therapeutic advantages over other formulations, including ease of application and rapid distribution over large bleeding surfaces. The efficacy of powder-based hemostats is dependent on device performance, which is rarely investigated independently from efficacy. OBJECTIVES: The current study aimed to compare the hemostatic efficacy of an oxidized regenerated cellulose agent (Surgicel, Ethicon, Inc) and 3 starch-based biopolymers (Arista, Becton Dickinson
PerClot, Baxter International
and 4DryField, PlantTec Medical GmbH) and the performance of their delivery device applicators. METHODS: Efficacy was evaluated in a porcine model of bleeding using 2 study designs where the powder was delivered with (experiment 1) and without (experiment 2) device applicators. Device performance (powder expression) was examined RESULTS: Surgicel efficacy rate was noninferior ( CONCLUSION: The oxidized regenerated cellulose powder was the most efficacious hemostat, and the Surgicel applicator exhibited the highest performance compared with any of the 3 starch-based devices investigated. The current study highlights the relevance of combining high-efficacy powder hemostats with innovative, high-performance applicators to effectively manage bleeding control in surgical settings.