Management of non-compressible torso hemorrhage: An update

Zhang, Zhi-Yang; Zhang, Huayu; Talmy, Tomer; Yu, Guo; Zhou, Siru; Zhang, Lianyang; Yang, Li

doi:10.1016/j.cjtee.2021.03.005

Cited by 17 publications

(10 citation statements)

References 59 publications

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“…As for hemostatic agents, effective absorbance allows wound exudates to stay longer within the wound site and proceed with adequate oxygenation for wound healing . The maintenance of moist conditions accelerates revascularization, growth factor, and cell interactions and eventually results in wound recovery. − Among diverse formulations, the sponge is the excellent one possessing the number of pores. The SF/ST blend solution was freeze-dried, and the SEM image displays its cross-sectional view.…”

Section: Resultsmentioning

confidence: 99%

Microporous Hemostatic Sponge Based on Silk Fibroin and Starch with Increased Structural Retentivity for Contact Activation of the Coagulation Cascade

et al. 2023

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Hemostatic agents with diverse forms and materials are necessitated to control excessive bleeding to improve surgical site visibility during operation. The adequate use of hemostatic agents dramatically reduces the chance of dehydration, absence of oxygen, and, in severe cases, death. Polysaccharide-based hemostatic agents are widely used as they are safe for the human body. Among diverse polysaccharides, starch has exhibited a high swelling ability, but its powder formulation is limited during incompressible bleeding. Herein, starch was blended with silk protein and crosslinked using glycerol to improve structural integrity. The silk/starch solution was lyophilized to be a sponge with interconnected pores, which is beneficial to blood coagulation by increased swelling ratio and underwater retentivity to absorb blood plasma. The surface contact between the blood component and the sponge initiates clotting by intrinsic pathway activation and platelet activation without the hemolytic effect or cytotoxicity. The clinical effectiveness of the sponges as topical hemostatic agents was confirmed by animal bleeding model tests.

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Section: Resultsmentioning

confidence: 99%

Microporous Hemostatic Sponge Based on Silk Fibroin and Starch with Increased Structural Retentivity for Contact Activation of the Coagulation Cascade

et al. 2023

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“…With gradually increased understanding of the haemostatic process, various haemostatic materials that mimic the human haemostatic mechanism have been developed. Tourniquets, gauze, sponges, and bioadhesives are common types of haemostatic materials, and some marketed haemostatic materials, such as X-STAT, junctional tourniquets and pelvic binders, have shown excellent haemostatic properties in surgical and battlefield emergencies ( Zhang et al, 2021 ). However, there is still a lack of effective treatments for noncompressible bleeding in the chest and abdominal organs.…”

Section: Introductionmentioning

confidence: 99%

Progress in injectable hydrogels for the treatment of incompressible bleeding: an update

Wang,

Yang,

Sun

et al. 2024

Front. Bioeng. Biotechnol.

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Uncontrollable haemorrhage from deep, noncompressible wounds remains a persistent and intractable challenge, accounting for a very high proportion of deaths in both war and disaster situations. Recently, injectable hydrogels have been increasingly studied as potential haemostatic materials, highlighting their enormous potential for the management of noncompressible haemorrhages. In this review, we summarize haemostatic mechanisms, commonly used clinical haemostatic methods, and the research progress on injectable haemostatic hydrogels. We emphasize the current status of injectable hydrogels as haemostatic materials, including their physical and chemical properties, design strategy, haemostatic mechanisms, and application in various types of wounds. We discuss the advantages and disadvantages of injectable hydrogels as haemostatic materials, as well as the opportunities and challenges involved. Finally, we propose cutting-edge research avenues to address these challenges and opportunities, including the combination of injectable hydrogels with advanced materials and innovative strategies to increase their biocompatibility and tune their degradation profile. Surface modifications for promoting cell adhesion and proliferation, as well as the delivery of growth factors or other biologics for optimal wound healing, are also suggested. We believe that this paper will inform researchers about the current status of the use of injectable haemostatic hydrogels for noncompressible haemorrhage and spark new ideas for those striving to propel this field forward.

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“…However, Bonanno et al reported that this design reduced the overall survival rate, which may be due to changes in liquid absorption and expansion of sponge pellets . In general, XSTAT is effective, but according to Tactical Combat Casualty Care (TCCC) guidelines, it still has drawbacks, including the following: (1) sponges need to be removed within 4 h of application per the FDA clearance letter; − (2) one or more of the mini-sponges has potential for occlusion of the carotid or jugular vessels, so radiological clearance must be employed after removal of sponges; and (3) one wound typically requires three XSTAT dressings, which costs approximately $1000. ,, Other dressings are in development, but in general, none have emerged as both safe and effective for use in noncompressible wounds.…”

Section: Introductionmentioning

confidence: 99%

Dual Burst and Sustained Release of p-Coumaric Acid from Shape Memory Polymer Foams for Polymicrobial Infection Prevention in Trauma-Related Hemorrhagic Wounds

Fikhman

Persaud

et al. 2023

ACS Appl. Mater. Interfaces

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Hemorrhage is the primary cause of trauma-related death. Of patients that survive, polymicrobial infection occurs in 39% of traumatic wounds within a week of injury. Moreover, traumatic wounds are susceptible to hospital-acquired and drug-resistant bacterial infections. Thus, hemostatic dressings with antimicrobial properties could reduce morbidity and mortality to enhance traumatic wound healing. To that end, p-coumaric acid (PCA) was incorporated into hemostatic shape memory polymer foams by two mechanisms (chemical and physical) to produce dual PCA (DPCA) foams. DPCA foams demonstrated excellent antimicrobial and antibiofilm properties against native Escherichia coli, Staphylococcus aureus, and Staphylococcus epidermidis; co-cultures of E. coli and S. aureus; and drug-resistant S. aureus and S. epidermidis at short (1 h) and long (7 days) time points. Resistance against biofilm formation on the sample surfaces was also observed. In ex vivo experiments in a porcine skin wound model, DPCA foams exhibited similarly high antimicrobial properties as those observed in vitro, indicating that PCA was released from the DPCA foam to successfully inhibit bacterial growth. DPCA foams consistently showed improved antimicrobial properties relative to those of clinical control foams containing silver nanoparticles (AgNPs) against single and mixed species bacteria, single and mixed species biofilms, and bacteria in the ex vivo wound model. This system could allow for physically incorporated PCA to first be released into traumatic wounds directly after application for instant wound disinfection. Then, more tightly tethered PCA can be continuously released into the wound for up to 7 days to kill additional bacteria and protect against biofilms.

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Management of non-compressible torso hemorrhage: An update

Cited by 17 publications

References 59 publications

Microporous Hemostatic Sponge Based on Silk Fibroin and Starch with Increased Structural Retentivity for Contact Activation of the Coagulation Cascade

Microporous Hemostatic Sponge Based on Silk Fibroin and Starch with Increased Structural Retentivity for Contact Activation of the Coagulation Cascade

Progress in injectable hydrogels for the treatment of incompressible bleeding: an update

Dual Burst and Sustained Release of p-Coumaric Acid from Shape Memory Polymer Foams for Polymicrobial Infection Prevention in Trauma-Related Hemorrhagic Wounds

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