title: Fibrin sealant foam sprayed directly on liver injuries decreases blood loss in resuscitated rats.
abstract: OBJECTIVE
  The majority of early trauma deaths are attributable to uncontrolled hemorrhage from truncal sites. A hemorrhage-control technique that reduced bleeding in the prehospital phase of treatment without requiring manual compression may improve the outcome of these patients. We conducted this preliminary study to determine whether an expanding fibrin sealant foam (FSF) would reduce bleeding from a severe liver injury even during resuscitation.
  
  
  METHODS
  Rats (n = 31; 291 +/- 5 g; 37.4 +/- 0.3 degrees C; mean +/- SEM), underwent a 60 +/- 5% excision of the median hepatic lobe. The animals received one of three treatments: (1) FSF, (2) immunoglobulin G placebo foam (IgGF), or (3) no treatment. All animals were resuscitated with 40 degrees C lactated Ringer's solution at 3.3 mL/ min/kg to a mean arterial pressure of 100 mm Hg. Total blood loss, mean arterial pressure, and resuscitation volume were recorded for 30 minutes. A qualitative measure of foam coverage and adherence to the cut liver edge was recorded.
  
  
  RESULTS
  The total blood loss was less (p < 0.01) in the FSF group (21.2 +/- 5.0 mL/kg) than in either IgGF (41.4 +/- 4.3 mL/kg) or the no treatment group (44.6 +/- 4.7 mL/kg), which did not differ. The resuscitation volume was not different. The amount of foam used in the treated groups, 9.1 +/- 1.0 g in the FSF group and 10.0 +/- 1.0 g in the IgGF group, did not differ. Survival for 30 minutes was not different among groups. There was no difference in the amount of cut liver covered by either foam, but the clots were more adherent (p < 0.05) in the FSF group than in the IgGF group.
  
  
  CONCLUSIONS
  In rats with a severe liver injury, spraying fibrin foam directly on the cut liver surface decreased blood loss when compared with placebo foam and no treatment. This pilot study suggests a future possible treatment for noncompressible truncal hemorrhage.
authors.affiliation: Joint Trauma Training Center, Ben Taub General Hospital, BCM, Houston, USA. JBHolcomb@dmrti.army.mil
authors.forename: J B
authors.initials: JB
authors.lastname: Holcomb
authors.forename: J M
authors.initials: JM
authors.lastname: McClain
authors.forename: A E
authors.initials: AE
authors.lastname: Pusateri
authors.forename: D
authors.initials: D
authors.lastname: Beall
authors.forename: J M
authors.initials: JM
authors.lastname: Macaitis
authors.forename: R A
authors.initials: RA
authors.lastname: Harris
authors.forename: M J
authors.initials: MJ
authors.lastname: MacPhee
authors.forename: J R
authors.initials: JR
authors.lastname: Hess
mesh_terms: D000287:Administration, Topical; D000336:Aerosols; D000818:Animals; D004195:Disease Models, Animal; D005339:Fibrin Foam / Q000008:administration & dosage*; D006470:Hemorrhage / Q000517:prevention & control*; D006490:Hemostatics / Q000008:administration & dosage*; D008099:Liver / Q000293:injuries* / Q000473:pathology; D008107:Liver Diseases / Q000517:prevention & control*; D010865:Pilot Projects; D011897:Random Allocation; D051381:Rats; D017207:Rats, Sprague-Dawley; D012151:Resuscitation
chemical_list: D000336:Aerosols; D005339:Fibrin Foam; D006490:Hemostatics