Effect of Dry Fibrin Sealant Dressings versus Gauze Packing on Blood Loss in Grade V Liver Injuries in Resuscitated Swine

Holcomb, John B.; Pusateri, Anthony E.; Harris, Richard; Charles, Nathaniel C.; Gomez, Richard B.; Cole, James P.; Beall, L D; Bayer, Vladislav; MacPhee, Martin; Hess, John R.

doi:10.1097/00005373-199901000-00009

Cited by 117 publications

(86 citation statements)

References 23 publications

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“…To create a variety of high-pressure ⁄ high-flow and low-pressure ⁄ low-flow states, bleeding time has varied in previous studies. [6][7][8][9][10][15][16][17][18] We chose to replicate a 3-minute bleed, which has clearly been demonstrated to produce a fatal wound. 7 While we are not aware of any existing field data that document average time to intervention in the operational environment, we believe that 3 minutes of bleeding is a gross estimate of the likely delay to care encountered on the battlefield.…”

Section: Discussionmentioning

confidence: 99%

An Alternative Hemostatic Dressing: Comparison of CELOX, HemCon, and QuikClot

Kozen

Kircher

Henao

et al. 2008

Academic Emergency Medicine

269

158

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Objectives: Uncontrolled hemorrhage remains a leading cause of traumatic death. Several topical adjunct agents have been shown to be effective in controlling hemorrhage, and two, chitosan wafer dressing (HemCon [HC]) and zeolite powder dressing (QuikClot [QC]), are being utilized regularly on the battlefield. However, recent literature reviews have concluded that no ideal topical agent exists. The authors compared a new chitosan granule dressing (CELOX [CX]) to HC, QC and standard dressing in a lethal hemorrhagic groin injury.Methods: A complex groin injury with transection of the femoral vessels and 3 minutes of uncontrolled hemorrhage was created in 48 swine. The animals were then randomized to four treatment groups (12 animals each). Group 1 included standard gauze dressing (SD); Group 2, CX; Group 3, HC; and Group 4, QC. Each agent was applied with 5 minutes of manual pressure followed by a standard field compression dressing. Hetastarch (500 mL) was infused over 30 minutes. Hemodynamic parameters were recorded over 180 minutes. Primary endpoints included rebleed and death.Results: CX reduced rebleeding to 0% (p < 0.001), HC to 33% (95% CI = 19.7% to 46.3%, p = 0.038), and QC to 8% (95% CI = 3.3% to 15.7%, p = 0.001), compared to 83% (95% CI = 72.4% to 93.6%) for SD. CX improved survival to 100% compared to SD at 50% (95% CI = 35.9% to 64.2%, p = 0.018). Survival for HC (67%) (95% CI = 53.7% to 80.3%) and QC (92%; 95% CI = 84.3% to 99.7%) did not differ from SD. Conclusions:In this porcine model of uncontrolled hemorrhage, CX improved hemorrhage control and survival. CELOX is a viable alternative for the treatment of severe hemorrhage.ACADEMIC EMERGENCY MEDICINE 2008; 15:74-81 ª

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Section: Discussionmentioning

confidence: 99%

An Alternative Hemostatic Dressing: Comparison of CELOX, HemCon, and QuikClot

Kozen

Kircher

Henao

et al. 2008

Academic Emergency Medicine

269

158

View full text Add to dashboard Cite

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“…Although the number of gauze packs did not differ among treatment groups, there was concern that the number used per pig (-23, Table 2) was greater than in previous studies (13-17 gauze packs; Holcomb et al, 1999a;Holcomb et al, 1999b), and that the increased gauzes might be associated with increased abdominal pressure and compartment syndrome. As an indirect measure of this potential complication (Ertel et al, 2000) the ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO 2 /FiO 2 ; Horowitz coefficient) was examined.…”

Section: Horowitz Coefficient and Inspiratory Airway Pressurementioning

confidence: 70%

“…Liver injuries were induced as previously reported (Holcomb et al, 1999a(Holcomb et al, , 1999b. Briefly, the liver was retracted by manually elevating the left and right medial lobes to allow adequate exposure.…”

Section: Methodsmentioning

confidence: 99%

Effect of Recombinant FVIIa in Hypothermic, Coagulopathic Pigs with Liver Injuries

Klemcke

Delgado

Holcomb

et al. 2005

The Journal of Trauma: Injury, Infection, and Critical Care

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“…The requirements of the model to test these new devices included focal arterial injuries with defined rates of bleeding. Previously described models of arterial injury were unsuitable because of hemodynamic instability or lack of information on bleeding rate at the site of injury (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). This model provides a stable test-bed with variable and controllable rates of arterial hemorrhage which can be used to study the characteristics of the bleeding site and the effectiveness of measures directed at the bleeding site.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies have utilized localized incisions in peripheral or central arteries (11)(12)(13)(14)(15), while others have utilized uncontrolled blast injuries which include soft tissue as well as vascular injury (16,17). A number of models include extensive liver lacerations (18,19,20), while others utilized side-hole injuries in the aorta (21, 22, 23). However, none of these studies assessed the injured artery bleeding rate separately and distinctly from the hemorrhagic shock response to the injury.…”

Section: Methodsmentioning

confidence: 99%

Localized Control of Exsanguinating Arterial Hemorrhage: An Experimental Model

Haick¹,

Abilez²,

Johnson³

et al. 2011

Polish Journal of Surgery

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To develop an arterial injury model for testing hemostatic devices at well-defined high and low bleeding rates. material and method. A side-hole arterial injury was created in the carotid artery of sheep. Shed blood was collected in a jugular venous reservoir and bleeding rate at the site of arterial injury was controlled by regulating outflow resistance from the venous reservoir. Two models were studied: uncontrolled exsanguinating hemorrhage and bleeding at controlled rates with blood return to maintain hemodynamic stability. Transcutaneous Duplex ultrasound was used to characterize ultrasound signatures at various bleeding rates. Results. A 2.5 mm arterial side-hole resulted in exsanguinating hemorrhage with an initial bleeding rate of 400 ml/min which, without resuscitation, decreased to below 100 ml/min in 5 minutes. After 17 minutes, bleeding from the injury site stopped and the animal had lost 60% of total blood volume. Reinfusion of shed blood maintained normal hemodynamics and both high and low bleeding rates could be maintained without hemorrhagic shock. Bleeding rate at the arterial injury site was held at 395±78 ml/min for 8 minutes, 110±11 ml/min for 15 minutes, and 12±1 ml/min for 12 minutes. Doppler flow signatures at the site of injury were characterized by high peak and end-diastolic flow velocities at the bleeding site which varied with the rate of hemorrhage. conclusion. We have developed a hemodynamically stable model of acute arterial injury which can be used to evaluate diagnostic and treatment methods focused on control of the arterial injury site.

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Effect of Dry Fibrin Sealant Dressings versus Gauze Packing on Blood Loss in Grade V Liver Injuries in Resuscitated Swine

Cited by 117 publications

References 23 publications

An Alternative Hemostatic Dressing: Comparison of CELOX, HemCon, and QuikClot

An Alternative Hemostatic Dressing: Comparison of CELOX, HemCon, and QuikClot

Effect of Recombinant FVIIa in Hypothermic, Coagulopathic Pigs with Liver Injuries

Localized Control of Exsanguinating Arterial Hemorrhage: An Experimental Model

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