title: Self-expanding polyurethane polymer improves survival in a model of noncompressible massive abdominal hemorrhage.
abstract: BACKGROUND
  Intracavitary noncompressible hemorrhage remains a significant cause of preventable death on the battlefield. Two dynamically mixed and percutaneously injected liquids were engineered to create an in situ self-expanding polymer foam to facilitate hemostasis in massive bleeding. We hypothesized that intraperitoneal injection of the polymer could achieve conformal contact with sites of injury and improve survival in swine with lethal hepatoportal injury.
  
  
  METHODS
  High grade hepatoportal injury was created in a closed abdominal cavity, resulting in massive noncoagulopathic, noncompressible hemorrhage. Animals received either standard battlefield fluid resuscitation (control, n = 12) or fluid resuscitation plus intraperitoneal injection of hemostatic foam (polymer, n = 15) and were monitored for 3 hours. Blood loss was quantified, and all hepatoportal injuries were inspected for consistency.
  
  
  RESULTS
  Before intervention, all animals initially experienced severe, profound hypotension and near-arrest (mean arterial pressure at 10 minutes, 21 [5.3] mm Hg). Overall survival at 3 hours was 73% in the polymer group and 8% in the control group (p = 0.001). Median survival time was more than 150 minutes in the polymer group versus 23 minutes (19-41.5 minutes) in the control group (p < 0.001), and normalized blood loss in the polymer group was 0.47 (0.30) g/kg per minute versus 3.0 (1.3) g/kg per minute in the controls (p = < 0.001). All hepatoportal injuries were anatomically similar, and the polymer had conformal contact with injured tissues.
  
  
  CONCLUSIONS
  Intraperitoneal polymer injection during massive noncompressible hemorrhage reduces blood loss and improves survival in a lethal, closed-cavity, hepatoportal injury model. Chronic safety and additional efficacy studies in other models are needed.
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Duggan
authors.forename: Adam
authors.initials: A
authors.lastname: Rago
authors.forename: Upma
authors.initials: U
authors.lastname: Sharma
authors.forename: Greg
authors.initials: G
authors.lastname: Zugates
authors.forename: Toby
authors.initials: T
authors.lastname: Freyman
authors.forename: Rany
authors.initials: R
authors.lastname: Busold
authors.forename: John
authors.initials: J
authors.lastname: Caulkins
authors.forename: Quynh
authors.initials: Q
authors.lastname: Pham
authors.forename: Yuchaio
authors.initials: Y
authors.lastname: Chang
authors.forename: Ali
authors.initials: A
authors.lastname: Mejaddam
authors.forename: John
authors.initials: J
authors.lastname: Beagle
authors.forename: George
authors.initials: G
authors.lastname: Velmahos
authors.forename: Marc
authors.initials: M
authors.lastname: deMoya
authors.forename: Lawrence
authors.initials: L
authors.lastname: Zukerberg
authors.forename: Tat Fong
authors.initials: TF
authors.lastname: Ng
authors.forename: David R
authors.initials: DR
authors.lastname: King
mesh_terms: D000007:Abdominal Injuries / Q000628:therapy*; D000818:Animals; D004195:Disease Models, Animal; D058734:Exsanguination / Q000401:mortality / Q000628:therapy*; D006489:Hemostatic Techniques / Q000401:mortality; D007274:Injections, Intraperitoneal; D008099:Liver / Q000098:blood supply / Q000293:injuries; D011140:Polyurethanes / Q000008:administration & dosage; D011168:Portal System / Q000293:injuries; D012151:Resuscitation; D013552:Swine
chemical_list: D011140:Polyurethanes