Dry fibrin sealant dressings reduce blood loss, resuscitation volume, and improve survival in hypothermic coagulopathic swine with grade V liver injuries.
OBJECTIVE
The majority of early trauma deaths are caused by uncontrolled hemorrhage, and are frequently complicated by hypothermic and dilutional coagulopathies. Any hemorrhage-control technique that achieves rapid hemostasis despite a coagulopathy should improve the outcome of these patients. We conducted this study to determine whether dry fibrin sealant dressings (DFSD) would stop bleeding from grade V liver injuries in swine that were hypothermic and coagulopathic.


METHODS
Nineteen swine weighing 39.7 kg (mean and 95% confidence interval, 36.3-43.1), underwent a 60% isovolemic, hypothermic exchange transfusion with 33 degrees C 6% hetastarch to produce a dilutional and hypothermic coagulopathy. The animals then received a grade V liver injury and one of three treatments: DFSD, conventional liver packing with gauze sponges, or immunoglobulin G (IgG) placebo sealant dressing (blinded control). All animals were resuscitated with lactated Ringer's solution to their preinjury mean arterial pressure. Blood loss after treatment, mean arterial pressure, resuscitation volume, hematologic variables, and core temperature were monitored for 1 hour.


RESULTS
At the time of injury, core temperature = 33.3 degrees C (95% confidence interval, 33.2-33.4), hemoglobin concentration = 4.4 g/dL (4.2-4.6), platelet count = 132 x 10(5)/microL, (93-171), prothrombin time = 21.6 seconds (19.6-23.5), activated partial thromboplastin time = 25.2 seconds (range, 22.9-27.5 seconds), and fibrinogen = 83 mg/dL (range, 76-89 mg/dL) across treatments. The posttreatment blood loss in the DFSD group was 669 mL, (range, 353-1,268 mL), which was lower (p < 0.01) than the means of 3,321 mL (range, 1,891-5,831 mL) and 4,399 mL (range, 2,321-8,332 mL) observed in the packing and IgG groups, respectively. The resuscitation volume in DFSD was 2,145 mL (range 1,310-3,514 mL), which was lower (p < 0.05) than the means of 5,222 mL (range 3,381-8,067 mL) and 5,542 mL (range 3,384-9,077 mL) in the packing and IgG groups, respectively. One-hour survival in the DFSD group was 83%, whereas survival in the packing and IgG groups were 0% (p < 0.05).


CONCLUSIONS
In swine with a grade V liver injury complicated by a dilutional and hypothermic coagulopathy, DFSD provided simple, rapid hemorrhage control, decreased fluid requirements, and improved survival.
Holcomb
J B
JB
Department of Clinical Investigation, Brooke Army Medical Center, Fort Sam Houston, Texas, USA. JBHolcomb@DMRTI.army.mil
Pusateri
A E
AE
Harris
R A
RA
Reid
T J
TJ
Beall
L D
LD
Hess
J R
JR
MacPhee
M J
MJ
D000818:Animals; D001458:Bandages; D001778:Blood Coagulation Disorders / Q000150:complications*; D001794:Blood Pressure; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D006454:Hemoglobins; D006470:Hemorrhage / Q000150:complications / Q000628:therapy*; D007035:Hypothermia / Q000150:complications*; D007074:Immunoglobulin G / Q000627:therapeutic use; D008099:Liver / Q000293:injuries*; D012151:Resuscitation / Q000379:methods*; D013552:Swine
D015718:Fibrin Tissue Adhesive; D006454:Hemoglobins; D007074:Immunoglobulin G