NDLI: 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.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Delgado, Angel V. Kheirabadi, Bijan S. Fruchterman, Todd M. Scherer, Michael Cortez, Douglas Wade, Charles E. Dubick, Michael A. Holcomb, John B.
Description	Country affiliation: United States Author Affiliation: Delgado AV ( US Army Institute of Surgical Research, San Antonio, Texas, USA. angel.delgado@amedd.army.mil)
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.
File Format	HTM / HTML
ISSN	00225282
Issue Number	1
Volume Number	64
e-ISSN	15298809
Journal	The Journal of Trauma: Injury, Infection, and Critical Care
Language	English
Publisher	Lippincott Williams & Wilkins
Publisher Date	2008-01-01
Publisher Place	United States
Access Restriction	Subscribed
Subject Keyword	Fluid Therapy Therapy Blood Coagulation Disorders Bandages Complications Liver Male Fibrin Tissue Adhesive Hemorrhage Discipline Traumatology Journal Article Shock, Hemorrhagic Animals Etiology Hemostatic Techniques Blood Coagulation Tests Sus Scrofa Female Hemostatics Injuries Resuscitation Disease Models, Animal Hypothermia
Content Type	Text
Resource Type	Article
Subject	Surgery Critical Care and Intensive Care Medicine

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