Advanced hemostatic dressing development program: animal model selection criteria and results of a study of nine hemostatic dressings in a model of severe large venous hemorrhage and hepatic injury in Swine.
BACKGROUND
An advanced hemostatic dressing is needed to augment current methods for the control of life-threatening hemorrhage. A systematic approach to the study of dressings is described. We studied the effects of nine hemostatic dressings on blood loss using a model of severe venous hemorrhage and hepatic injury in swine.


METHODS
Swine were treated using one of nine hemostatic dressings. Dressings used the following primary active ingredients: microfibrillar collagen, oxidized cellulose, thrombin, fibrinogen, propyl gallate, aluminum sulfate, and fully acetylated poly-N-acetyl glucosamine. Standardized liver injuries were induced, dressings were applied, and resuscitation was initiated. Blood loss, hemostasis, and 60-minute survival were quantified.


RESULTS
The American Red Cross hemostatic dressing (fibrinogen and thrombin) reduced (p < 0.01) posttreatment blood loss (366 mL; 95% confidence interval, 175-762 mL) and increased (p < 0.05) the percentage of animals in which hemostasis was attained (73%), compared with gauze controls (2,973 mL; 95% confidence interval, 1,414-6,102 mL and 0%, respectively). No other dressing was effective. The number of vessels lacerated was positively related to pretreatment blood loss and negatively related to hemostasis.


CONCLUSIONS
The hemorrhage model allowed differentiation among topical hemostatic agents for severe hemorrhage. The American Red Cross hemostatic dressing was effective and warrants further development.
D000818:Animals; D001458:Bandages; D001794:Blood Pressure; D003094:Collagen / Q000627:therapeutic use; D016001:Confidence Intervals; D004195:Disease Models, Animal; D005260:Female; D005340:Fibrinogen / Q000627:therapeutic use; D006470:Hemorrhage / Q000628:therapy*; D006489:Hemostatic Techniques; D006490:Hemostatics / Q000627:therapeutic use*; D008099:Liver / Q000293:injuries*; D008297:Male; D011435:Propyl Gallate / Q000627:therapeutic use; D013552:Swine; D013917:Thrombin / Q000627:therapeutic use
D006490:Hemostatics; D011435:Propyl Gallate; D005340:Fibrinogen; D003094:Collagen; D013917:Thrombin