title: Modified rapid deployment hemostat bandage reduces blood loss and mortality in coagulopathic pigs with severe liver injury.
abstract: BACKGROUND
  Hemostasis can be difficult to achieve after blunt abdominal trauma, especially if the patient is coagulopathic. The U.S. Food and Drug Administration has recently approved a hemostatic dressing for treating bleeding after extremity trauma (RDH bandage; Marine Polymer Technologies, Cambridge, MA). It has not been evaluated for internal bleeding after trauma. We redesigned this dressing for internal use, and then tested whether this modified bandage (Miami-modified Rapid Deployment Hemostat) could achieve hemostasis when used as an adjunct to standard laparotomy pad packing in a pig model of severe liver injury with coagulopathy.
  
  
  METHODS
  Anesthetized swine (35-45 kg) received an isovolemic 45% blood volume replacement with refrigerated Hextend (6% hetastarch). Core body temperature was maintained at 33-34 degrees C with intra-abdominal ice packs. A coagulopathic condition was documented by thromboelastography. At this point a severe liver injury was induced by the avulsion of the left lateral hepatic lobe, then the pigs were randomized to treatment with either standard abdominal packing (control) or packing plus Miami-modified Rapid Deployment Hemostat. Two series of experiments were conducted. In series one (n = 14), the abdomen was closed and the animals were observed with no resuscitation. After one hour, the abdomen was opened, the packing was removed and the presence of bleeding was noted. In series two (n = 10), the abdomen was closed and the animal resuscitated with one unit of blood plus as much lactated Ringers intravenous fluid (IVF) as required to maintain a mean arterial pressure (MAP) > 70 mm Hg. After one hour, the packing was removed, the abdomen closed, and data were collected for an additional two hours.
  
  
  RESULTS
  Series one: 6/7 animals in the control group had continued bleeding at one hour; 1/7 animals in the treatment group had active bleeding (p = 0.0291). Series two: With control vs. Miami-modified Rapid Deployment Hemostat, the three-hour survival was zero vs. 80% (p = 0.0476). The total blood loss was 1.2 +/- 0.1 vs. 0.3 +/- 0.1 mL/kg/min (p = 0.001) and the IVF requirement was 1.6 +/- 0.3 vs. 0.6 +/- 0.3 mL/kg/min (p = 0.026).
  
  
  CONCLUSIONS
  The Miami-modified Rapid Deployment Hemostat bandage significantly reduced mortality, blood loss, and fluid requirements when used as an adjunct to standard abdominal packing following severe liver injury in coagulopathic pigs [corrected].
authors.affiliation: Daughtry Family Department of Surgery, Ryder Trauma Center, University of Miami Medical School, Florida 33136, USA.
authors.forename: Dory D
authors.initials: DD
authors.lastname: Jewelewicz
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Cohn
authors.forename: B A
authors.initials: BA
authors.lastname: Crookes
authors.forename: K G
authors.initials: KG
authors.lastname: Proctor
mesh_terms: D000818:Animals; D001458:Bandages; D001778:Blood Coagulation Disorders / Q000150:complications / Q000401:mortality* / Q000517:prevention & control*; D004195:Disease Models, Animal; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control*; D006489:Hemostatic Techniques / Q000295:instrumentation*; D008099:Liver / Q000293:injuries*; D008297:Male; D015996:Survival Rate; D013552:Swine; D013997:Time Factors; D015599:Trauma Severity Indices