Contrast-enhanced sonographic guidance for local injection of a hemostatic agent for management of blunt hepatic hemorrhage: a canine study.
OBJECTIVE
The purpose of this study was to determine whether injection of hemostatic agents directly into an injury site under the guidance of contrast-enhanced sonography can effectively control hemorrhage due to hepatic trauma.


METHODS
Fifteen mixed-breed dogs 2-3 years old and weighing 17-20 kg were anesthetized with intramuscular pentobarbital sodium (30 mg/kg). A special impacting device was used to induce hepatic trauma with a mean force of 5.3 +/- 0.3 kN. Twelve of the 15 dogs had hepatic injuries with a grade of 3-4 or 4. The 12 dogs were divided into treatment and control groups. In the treatment group, hemocoagulase atrox (1 Klobusitzky unit) and alpha-cyanoacrylate (1 mL) were administered by transcutaneous injection into the injury site and the bleeding site, respectively, under the guidance of contrast-enhanced sonography. The control group received injections of 0.9% normal saline solution.


RESULTS
After injection into the treatment group, no active bleeding was observed at the liver injury site. In the control group, evidence of active bleeding was present on contrast-enhanced sonograms. Laparotomy of the treatment group showed that hepatic injuries had been covered and adhered by clots and the glue membrane of the hemostatic agents and that free intraperitoneal blood volume was significantly less than in the control group (p < 0.001). Bleeding did not stop in the control group.


CONCLUSIONS
In dogs, transcutaneous local injection of hemostatic agents can effectively reduce blood loss due to severe liver trauma. Because it is simple, convenient, and effective, the technique may be an alternative for bedside and battlefield management of hepatic hemorrhage due to trauma.
Tang
Jie
J
Department of Ultrasound, Chinese People's Liberation Army General Hospital, 28 Fuxing Rd., Beijing 100853, China. tangxier@163.com
Lv
Faqin
F
Li
Wenxiu
W
Zhang
Huiqin
H
Luo
Yukun
Y
An
Lichun
L
Li
Tanshi
T
D000818:Animals; D004285:Dogs; D005260:Female; D006470:Hemorrhage / Q000000981:diagnostic imaging* / Q000517:prevention & control*; D006490:Hemostatics / Q000008:administration & dosage*; D007267:Injections / Q000379:methods; D008099:Liver / Q000000981:diagnostic imaging / Q000293:injuries*; D008107:Liver Diseases / Q000000981:diagnostic imaging* / Q000517:prevention & control*; D008297:Male; D010743:Phospholipids / Q000008:administration & dosage*; D013459:Sulfur Hexafluoride / Q000008:administration & dosage*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000188:drug therapy
D006490:Hemostatics; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride