title: High-pressure fibrin sealant foam: an effective hemostatic agent for treating severe parenchymal hemorrhage.
abstract: BACKGROUND
  The majority of early trauma deaths are related to uncontrolled, noncompressible, parenchymal hemorrhage from truncal injuries. The purpose of this study was to formulate a fibrin sealant foam (FSF) able to control severe parenchymal bleeding without compression or vascular control.
  
  
  METHODS
  FSF with high fibrinogen concentration (20 mg/mL) and low thrombin activity (5 U/mL) was prepared and pressurized by addition of liquid gas propellant. The efficacy of this foam was tested against a severe parenchymal hemorrhage, created by partial resection of liver lobes in anticoagulated rabbits (n = 7) and compared to untreated injury (n = 8) and placebo treatment (n = 7). The hemostatic efficacy of pressurized FSF (n = 8) was also compared to a commercially available liquid fibrin sealant (n = 8) and a developing dry powdered fibrin sealant product (n = 8) in the same model.
  
  
  RESULTS
  The liver injury resulted in 122 +/- 11.5 mL blood loss and death of 75% of untreated rabbits (3.2-3.4 kg) within 1 h. Treatment with placebo foam had no effect on blood loss or mortality rate. Pressurized FSF significantly reduced bleeding, resulting in 56% (P < 0.05) and 66% (P < 0.01) reduction in blood loss as compared to untreated or placebo-treated animals, respectively, and 100% survival (P = 0.008). When pressurized FSF was compared with liquid and powdered forms of fibrin sealant, only foam significantly reduced blood loss (49%, P < 0.05) and mortality rate (54%, P < 0.05) of rabbits as compared to untreated control animals (n = 9).
  
  
  CONCLUSIONS
  Biological nature, rapid preparation, coverage of large wound areas, and effective hemostatic properties make pressurized FSF an ideal candidate for treating nonoperable parenchymal injuries in damage control procedures.
authors.affiliation: US Army Institute of Surgical Research, Fort Sam Houston, Texas 78234, USA. Bijan.Kheirabadi@CEN.AMEDD.ARMY.MIL
authors.forename: Bijan S
authors.initials: BS
authors.lastname: Kheirabadi
authors.forename: Jennifer
authors.initials: J
authors.lastname: Sieber
authors.forename: Tallat
authors.initials: T
authors.lastname: Bukhari
authors.forename: Kiti
authors.initials: K
authors.lastname: Rudnicka
authors.forename: Lara A
authors.initials: LA
authors.lastname: Murcin
authors.forename: David
authors.initials: D
authors.lastname: Tuthill
mesh_terms: D000818:Animals; D001458:Bandages; D001794:Blood Pressure; D004195:Disease Models, Animal; D005339:Fibrin Foam / Q000494:pharmacology*; D015718:Fibrin Tissue Adhesive / Q000494:pharmacology*; D006470:Hemorrhage / Q000401:mortality / Q000628:therapy*; D006490:Hemostatics / Q000494:pharmacology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008099:Liver / Q000098:blood supply / Q000293:injuries* / Q000601:surgery; D008297:Male; D011312:Pressure; D011817:Rabbits; D012720:Severity of Illness Index
chemical_list: D005339:Fibrin Foam; D015718:Fibrin Tissue Adhesive; D006490:Hemostatics