A novel biologic hemostatic dressing (fibrin patch) reduces blood loss and resuscitation volume and improves survival in hypothermic, coagulopathic Swine with grade V liver injury.

Abstract

OBJECTIVES:

This study evaluated the efficacy of a biologic hemostatic fibrin patch (FP) to control coagulopathic bleeding and prevent death in a porcine model of severe liver injury with hemodilution and hypothermia.

METHODS:

Coagulopathy was produced in swine by exchanging 60% of the animals' circulating blood volume with Hextend and lowering the core temperature to 32.0 degrees C +/- 0.5 degrees C. A grade V liver injury was induced and allowed to bleed freely for 30 seconds (pretreatment blood loss). Animals were randomly divided into three treatment groups: hepatic packing (HP) using laparotomy sponges, FP application plus HP, or placebo patch (PP) application plus HP. Animals were resuscitated to 80% of the preinjury mean arterial pressure. Core temperature, mean arterial pressure, and survival were monitored for 1 hour postinjury. Packs were removed from the animals that survived to 1 hour and they were monitored for an additional hour.

RESULTS:

Coagulopathy was confirmed by significant increases (p < 0.01) in prothrombin time, activated partial thromboplastin time, and activated clotting time in preinjury measurements as compared with baseline values. Pretreatment blood loss was not different among the groups. However, significant (p < 0.01) differences were observed in the posttreatment blood loss (772 mL +/- 340 mL, 4,977 mL +/- 440 mL, 4,173 mL +/- 608 mL), as well as the required fluid resuscitation volume (994 mL +/- 26 mL, 4,083 mL +/- 185 mL, 3,494 mL +/- 492 mL), between FP versus PP or HP groups, respectively. In addition, 89% of FP animals survived the 2-hour observation with an average survival time of 111 minutes +/- 9 minutes, which was significantly higher than the PP (0% survival, 39 minutes +/- 4 minutes) or HP (13% survival, 41 minutes +/- 12 minutes) groups.

CONCLUSION:

FP with packing effectively controlled coagulopathic bleeding and prevented death in a model of grade V liver injury in which HP alone (standard of care) was ineffective.

• Authors: Angel V Delgado, Bijan S Kheirabadi, Todd M Fruchterman, Michael Scherer, Douglas Cortez, Charles E Wade, Michael A Dubick, John B Holcomb
• Journal: The Journal of trauma (J Trauma) Vol. 64 Issue 1 Pg. 75-80 (Jan 2008) ISSN: 1529-8809 [Electronic] United States
• PMID: 18188102 (Publication Type: Journal Article)

Chemical References

• Fibrin Tissue Adhesive
• Hemostatics

Topics

• Animals
• Bandages
• Blood Coagulation Disorders (complications)
• Blood Coagulation Tests
• Disease Models, Animal
• Female
• Fibrin Tissue Adhesive
• Fluid Therapy
• Hemorrhage (etiology, therapy)
• Hemostatic Techniques
• Hemostatics
• Hypothermia (complications)
• Liver (injuries)
• Male
• Resuscitation
• Shock, Hemorrhagic
• Sus scrofa