Comparison of a new hemostatic agent to current combat hemostatic agents in a Swine model of lethal extremity arterial hemorrhage.
BACKGROUND
Gaining hemostatic control of lethal vascular injuries sustained in combat using topical agents remains a challenge. Recent animal testing using a lethal arterial injury model has demonstrated that QuikClot zeolite granules (QCG) and the HemCon chitosan bandage (HC) are not capable of providing hemostasis and improving survival over the Army gauze field bandage (AFB). We have developed a new hemostatic agent consisting of a granular combination of a smectite mineral and a polymer (WoundStat) capable of producing hemostasis in the face of high-pressure arterial bleeding. We compared the performance of WoundStat (WS) to QCG, HC, AFB, and the new QuikClot zeolite Advance Clotting Sponge (ACS) in a lethal vascular injury model.


METHODS
Hemostatic agents were tested using a lethal femoral artery vascular injury model. Twenty-five (5 per group) male swine (42 kg +/- 3 kg) were anesthetized, instrumented, and splenectomized. A lethal femoral artery injury was produced by creating a 6-mm arteriotomy in the vessel. After 45 seconds of hemorrhage, animals were randomized to be treated with AFB (control group), HC, QCG, ACS, or WS. Pressure (200 mm Hg) was applied over the product in the wound for 3 minutes. A second application and 3 additional minutes of pressure was provided if hemostasis was not achieved. Fluid resuscitation was begun at the time of application with 500 mL of Hextend, followed by lactated Ringer's solution at 100 mL/min to achieve and maintain a postapplication mean arterial blood pressure of 65 mm Hg. Animals were observed for 180 minutes or until death. Primary endpoints were survival, survival time, post-treatment blood loss, and amount of resuscitation fluid.


RESULTS
All animals treated with WS survived to 180 minutes and required only a single application. No animal in the AFB, QCG, or ACS group survived. One animal in the HC group survived. Survival (p < 0.05) and survival times (p < 0.0001) for WS animals were significantly greater than for all other groups. No significant difference in survival or survival time existed between the AFB, QCG, ACS, or HC groups. Post-treatment blood loss (p = 0.0099) and postresuscitation fluid volume (p = 0.006) was significantly less for animals treated with WS than for all other groups. No significant difference in these parameters existed between the AFB, QCG, ACS, and HC groups.


CONCLUSIONS
WS was superior to the other hemostatic agents tested in this study of lethal arterial vascular injury. Additional study is warranted on this agent to determine its potential for use in combat and civilian trauma.
Ward
Kevin R
KR
Department of Emergency Medicine,Virginia Commonwealth University, Virginia Commonwealth University Reanimation Engineering Shock Center, Richmond, Virginia 23298, USA. krward@vcu.edu
Tiba
M Hakam
MH
Holbert
William H
WH
Blocher
Charles R
CR
Draucker
Gerard T
GT
Proffitt
E Kate
EK
Bowlin
Gary L
GL
Ivatury
Rao R
RR
Diegelmann
Robert F
RF
D000287:Administration, Topical; D000818:Animals; D001458:Bandages; D004195:Disease Models, Animal; D005263:Femoral Artery / Q000293:injuries; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D005440:Fluid Therapy; D006470:Hemorrhage / Q000503:physiopathology / Q000628:therapy*; D006490:Hemostatics / Q000627:therapeutic use*; D008297:Male; D011336:Probability; D011897:Random Allocation; D012016:Reference Values; D012680:Sensitivity and Specificity; D015996:Survival Rate; D013552:Swine
D015718:Fibrin Tissue Adhesive; D006490:Hemostatics