title: Application of a zeolite hemostatic agent achieves 100% survival in a lethal model of complex groin injury in Swine.
abstract: BACKGROUND
  Techniques for better hemorrhage control after injury could change outcome. We have previously shown that a zeolite mineral hemostatic agent (ZH) can control aggressive bleeding through adsorption of water, which is an exothermic process. Increasing the residual moisture content (RM) of ZH can theoretically decrease heat generation, but its effect on the hemostatic properties is unknown. We tested ZH with increasing RM against controls and other hemostatic agents in a swine model of battlefield injury.
  
  
  METHODS
  A complex groin injury was created in 72 swine (37 +/- 0.8 kg). This included semitransection of the proximal thigh and complete division of the femoral artery and vein. After 3 minutes, the animals were randomized to 1 of 10 groups: group 1, no dressing (ND); group 2, standard dressing (SD); group 3, SD + 3.5 oz ZH with 1% RM (1% ZH); group 4, SD + 3.5 oz ZH with 4% RM (4% ZH); group 5, SD + 2 oz ZH with 1% RM (1% ZH 2oz); group 6, SD + 3.5 oz ZH with 8% RM (8% ZH); group 7, SD + chitosan-based hemostat, HemCon (HC); group 8, SD + 3.5 oz nonzeolite mineral hemostat, Quick Relief (NZH); group 9, SD + bovine clotting factors-based hemostat, Fast Act (FA); and group 10, SD + 30 g of starch-based hemostat, TraumaDex (TDex). Resuscitation (500 mL of Hespan over 30 minutes) was started 15 minutes after injury and hemodynamic monitoring was performed for 180 minutes. Primary endpoints were survival for 180 minutes and blood loss. In addition, maximum wound temperatures were recorded, and histologic damage to artery, vein, nerve, and muscle was documented.
  
  
  RESULTS
  Use of 1% ZH decreased blood loss and reduced mortality to 0% (p < 0.05). Increasing the RM adversely affected efficacy without any significant decrease in wound temperatures. Minimal histologic tissue damage was seen with ZH independent of the percentage of RM.
  
  
  CONCLUSIONS
  The use of zeolite hemostatic agent (1% residual moisture, 3.5 oz) can control hemorrhage and dramatically reduce mortality from a lethal groin wound.
authors.affiliation: Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA. halam@usuhs.mil
authors.forename: Hasan B
authors.initials: HB
authors.lastname: Alam
authors.forename: Zheng
authors.initials: Z
authors.lastname: Chen
authors.forename: Amin
authors.initials: A
authors.lastname: Jaskille
authors.forename: Racel Ireneo Luis C
authors.initials: RI
authors.lastname: Querol
authors.forename: Elena
authors.initials: E
authors.lastname: Koustova
authors.forename: Ryan
authors.initials: R
authors.lastname: Inocencio
authors.forename: Richard
authors.initials: R
authors.lastname: Conran
authors.forename: Adam
authors.initials: A
authors.lastname: Seufert
authors.forename: Nanna
authors.initials: N
authors.lastname: Ariaban
authors.forename: Kevin
authors.initials: K
authors.lastname: Toruno
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
mesh_terms: D000327:Adsorption; D000818:Animals; D001458:Bandages / Q000592:standards; D002302:Cardiac Output / Q000187:drug effects; D002686:Chitin / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D048271:Chitosan; D004195:Disease Models, Animal; D004353:Drug Evaluation, Preclinical; D005263:Femoral Artery / Q000293:injuries; D005268:Femoral Vein / Q000293:injuries; D006119:Groin / Q000098:blood supply / Q000293:injuries*; D006470:Hemorrhage / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D006490:Hemostatics / Q000494:pharmacology / Q000627:therapeutic use*; D008991:Monitoring, Physiologic; D011897:Random Allocation; D012151:Resuscitation / Q000379:methods; D015996:Survival Rate; D013552:Swine; D013848:Thigh / Q000293:injuries; D013997:Time Factors; D014857:Warfare; D014950:Wounds, Penetrating / Q000150:complications*; D017641:Zeolites / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D006490:Hemostatics; D017641:Zeolites; D002686:Chitin; D048271:Chitosan