Abstract | BACKGROUND: Intracavitary noncompressible hemorrhage remains a significant cause of preventable death on the battlefield and in the homeland. We previously demonstrated the hemostatic efficacy of an in situ self-expanding poly( urea) urethane foam in a severe, closed-cavity, hepatoportal exsanguination model in swine. We hypothesized that treatment with, and subsequent explantation of, foam would not adversely impact 28-day survival in swine. METHODS: Following a closed-cavity splenic transection, animals received either fluid resuscitation alone (control group, n = 6) or resuscitation plus foam treatment at doses of 100 mL (n = 6), 120 mL (n = 6), and 150 mL (n = 2). Foam was allowed to polymerize in situ and was explanted after 3 hours. The animals were recovered and monitored for 28 days. RESULTS: All 18 animals in the 100-mL, 120-mL, and control groups survived to the 28-day endpoint without complications. The 150-mL group was terminated after the acute phase (n = 2). En bloc explantation of the foam took less than 2 minutes and was associated with millimeter-sized remnant particles. All foam animals required some level of enteric repair (imbrication or resection). Excluding the aborted 150-mL group, all animals survived, with no differences in renal or hepatic function, serum chemistries, or semiquantitative abdominal adhesion scores. Histologic analysis demonstrated that remnant particles were associated with a fibrotic capsule and mild inflammation, similar to that of standard suture reaction. In addition, safety testing (including genotoxicity, pyrogenicity, and cytotoxicity) was performed consistent with the ISO-10993 standard, and the materials passed all tests. CONCLUSION: For a distinct dose range, 28-day recovery after foam treatment and explantation for noncompressible, intra-abdominal hemorrhage is not associated with significant physiologic or biochemical evidence of end-organ dysfunction. A foam volume exceeding the maximum tolerable dose was identified. Bowel repair is required to ensure survival.
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Authors | Adam P Rago, Michael J Duggan, John Beagle, Miroslav P Peev, John Marini, John O Hwabejire, Patricia Hannett, Greg Zugates, Rany Busold, Marc Helmick, George Velmahos, Marc A Demoya, Daniel Dante Yeh, Peter J Fagenholz, Upma Sharma, David R King |
Journal | The journal of trauma and acute care surgery
(J Trauma Acute Care Surg)
Vol. 77
Issue 3 Suppl 2
Pg. S127-33
(Sep 2014)
ISSN: 2163-0763 [Electronic] United States |
PMID | 25159345
(Publication Type: Journal Article, Research Support, U.S. Gov't, Non-P.H.S.)
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Chemical References |
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Topics |
- Abdominal Injuries
(mortality, therapy)
- Animals
- Disease Models, Animal
- Exsanguination
(mortality, therapy)
- Hemostatic Techniques
(adverse effects, mortality)
- Polymerization
- Polyurethanes
(adverse effects, therapeutic use)
- Swine
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