title: A pilot study of the use of kaolin-impregnated gauze (Combat Gauze) for packing high-grade hepatic injuries in a hypothermic coagulopathic swine model.
abstract: BACKGROUND
  Severe hepatic injuries may be highly lethal, and perihepatic packing remains the mainstay of treatment. This is not always successful, particularly in the setting of hypothermia and coagulopathy. Kaolin-impregnated Combat Gauze (CG) is an effective hemostatic dressing used primarily to treat external wounds. The objective of this study was to determine the ability of CG to control severe hemorrhage in hypothermic, coagulopathic swine with a high-grade hepatic injury.
  
  
  METHODS
  Anesthetized animals underwent splenectomy and were cooled to 32°C while undergoing a 60% exchange transfusion with Hextend. A grade V liver injury was created in the left middle hepatic lobe. Animals were allowed to freely bleed for 30 s and then randomized to treatment with CG or plain gauze laparotomy pads (PG) applied to the injury site. Animals were then resuscitated with warmed Hextend.
  
  
  RESULTS
  There was no difference between groups in preinjury hemodynamic or laboratory values. Animals packed with CG had less blood loss when compared with standard packing (CG = 25 mL/kg versus PG = 58 mL/kg, P = 0.05). There was a trend towards lower hetastarch resuscitation requirements in the CG group (CG = 7 mL/kg versus PG = 44 mL/kg, P = 0.06) but no statistically significant difference in mortality (CG = 13% versus PG = 50%, P = 0.11). Histology of the injury sites revealed more adherent clot in the CG group, but no inflammation, tissue necrosis, or residual material.
  
  
  CONCLUSIONS
  In pigs with severe hepatic injury, Combat Gauze reduced blood loss and resuscitation requirements when compared with plain laparotomy pads. Combat Gauze may be safe and effective for use on severe liver injuries.
authors.affiliation: Department of Trauma Surgery, South Sacramento Kaiser Permanente Medical Center, Sacramento, California, USA. matthewsena2004@yahoo.com
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Sena
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Douglas
authors.forename: Travis
authors.initials: T
authors.lastname: Gerlach
authors.forename: J Kevin
authors.initials: JK
authors.lastname: Grayson
authors.forename: Kullada O
authors.initials: KO
authors.lastname: Pichakron
authors.forename: Dustin
authors.initials: D
authors.lastname: Zierold
mesh_terms: D000818:Animals; D001458:Bandages; D001778:Blood Coagulation Disorders / Q000150:complications*; D004195:Disease Models, Animal; D005260:Female; D006470:Hemorrhage / Q000517:prevention & control*; D006489:Hemostatic Techniques; D006490:Hemostatics / Q000008:administration & dosage / Q000627:therapeutic use; D007036:Hypothermia, Induced / Q000009:adverse effects*; D015994:Incidence; D007249:Inflammation / Q000453:epidemiology; D007616:Kaolin / Q000008:administration & dosage / Q000627:therapeutic use*; D008099:Liver / Q000293:injuries*; D008297:Male; D009336:Necrosis / Q000453:epidemiology; D010865:Pilot Projects; D013552:Swine; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics; D007616:Kaolin
keywords: Animal model; Coagulopathy; Hemostatic agent; Hypothermia; Kaolin gauze; Liver injury