title: Comparative analysis of hemostatic agents in a swine model of lethal groin injury.
abstract: BACKGROUND
  Techniques for better hemorrhage control after injury could change outcome. A large-animal model of lethal, uncontrolled hemorrhage was developed to test whether the use of various hemostatic agents would decrease bleeding and improve early survival.
  
  
  METHODS
  A complex groin injury was created in 30 Yorkshire swine (42-55 kg) to produce uncontrolled hemorrhage. This injury included semitransection of the proximal thigh and complete division of the femoral artery and vein. After 5 minutes, the animals were randomized to (n = 6 animals per group) no dressing (ND), standard dressing (SD), SD and Rapid Deployment Hemostat (RDH) bandage, SD and QuikClot hemostatic agent (QC), or SD and TraumaDEX (TDEX). Limited volume 0.9% saline (1,000 mL over 30 minutes) resuscitation was started 30 minutes after injury. We measured blood loss, early mortality (180 minutes), and physiologic markers of hemorrhagic shock (e.g., cardiac output, blood pressure, hemoglobin, metabolic acidosis).
  
  
  RESULTS
  Application of wound dressing decreased mortality in all groups compared with the ND group (83% mortality). However, this difference was significant (p < 0.05) only for the QuikClot hemostatic agent (0% mortality). Before the application of dressing (first 5 minutes), there were no differences in blood loss between the groups. After application of dressings, the QC group had the lowest blood loss (4.4 +/- 1.4 mL/kg).
  
  
  CONCLUSIONS
  Of the hemostatic agents tested, QuikClot improved survival and decreased bleeding in a swine model of lethal vascular and soft tissue injury.
authors.affiliation: Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814, USA. halam@usuhs.mil
authors.forename: Hasan B
authors.initials: HB
authors.lastname: Alam
authors.forename: Gemma B
authors.initials: GB
authors.lastname: Uy
authors.forename: Dana
authors.initials: D
authors.lastname: Miller
authors.forename: Elena
authors.initials: E
authors.lastname: Koustova
authors.forename: Timothy
authors.initials: T
authors.lastname: Hancock
authors.forename: Ryan
authors.initials: R
authors.lastname: Inocencio
authors.forename: Daniel
authors.initials: D
authors.lastname: Anderson
authors.forename: Orlando
authors.initials: O
authors.lastname: Llorente
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
mesh_terms: D000818:Animals; D001458:Bandages; D001794:Blood Pressure / Q000187:drug effects; D002302:Cardiac Output / Q000187:drug effects; D006119:Groin / Q000293:injuries*; D006470:Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D006490:Hemostatics / Q000627:therapeutic use*; D019344:Lactic Acid / Q000097:blood; D023421:Models, Animal; D016019:Survival Analysis; D013552:Swine; D016896:Treatment Outcome; D014950:Wounds, Penetrating / Q000150:complications*
chemical_list: D006490:Hemostatics; D019344:Lactic Acid