Dextran polymer hemostatic dressing improves survival in liver injury model.
BACKGROUND
Improvements in early hemorrhage control could result in more favorable outcomes. Several advanced hemostatic dressings are available; however, none meets the ideal characteristics defined by the United States Army. We studied the effects of a new dextran polymer hemostatic dressing on survival, blood loss, and blood pressure in a swine model of severe liver injury.


METHODS
We randomized 12 Yorkshire swine to treatment with either standard laparotomy pads or laparotomy pads coated with a dextran polymer (Bloxx). These dressings are visually identical, and investigators were not informed of the dressing assignment. We transected the left medial lobe of the liver in the anesthetized swine with a large knife, applied dressings immediately, and held pressure for 7 min. The animals received a weight-based maintenance crystalloid infusion without further resuscitation. Endpoints were blood loss, blood pressure, early mortality (120 min), and tissue histology.


RESULTS
Baseline and pre-injury characteristics were similar between all animals. Three of six animals in the control group survived for 2 h while all six animals treated with Bloxx survived (P=0.05). Similarly, animals in the Bloxx group experienced less blood loss (10.4+/-8.8 mL/kg versus 28.3+/-13.0 mL/kg, P=0.025) and higher post-injury blood pressure than the control group. Bloxx was not associated with macroscopic or microscopic tissue damage.


CONCLUSIONS
Bloxx is superior to standard laparotomy sponges in this model of lethal liver injury. Further study of this dressing is warranted to determine its potential for use in civilian and military trauma.
Clay
Jared G
JG
Department of Surgery, David Grant Medical Center, Travis AFB, California 94535, USA. jared.clay@travis.af.mil
Zierold
Dustin
D
Grayson
Kevin
K
Battistella
Felix D
FD
D000818:Animals; D001458:Bandages; D001794:Blood Pressure; D003911:Dextrans / Q000627:therapeutic use*; D005260:Female; D006470:Hemorrhage / Q000628:therapy*; D006488:Hemostasis, Surgical; D006490:Hemostatics / Q000627:therapeutic use*; D007813:Laparotomy; D008099:Liver / Q000293:injuries*; D008297:Male; D011897:Random Allocation; D034421:Sus scrofa
D003911:Dextrans; D006490:Hemostatics