title: Self-expanding foam improves survival following a lethal, exsanguinating iliac artery injury.
abstract: BACKGROUND
  Noncompressible abdominal bleeding is a significant cause of preventable death on the battlefield and in the civilian setting, with no effective therapies available at point of injury. We previously reported that a self-expanding polyurethane foam significantly improved survival in a lethal hepatoportal injury model of massive venous hemorrhage. In this study, we hypothesized that foam treatment could improve survival in a lethal iliac artery injury model in noncoagulopathic swine.
  
  
  METHODS
  In swine with a closed abdomen, an iliac artery transection was created, resulting in massive noncompressible exsanguination. After injury, animals were treated with damage-control fluid resuscitation alone (n = 14) or foam treatment in addition to fluids. Two doses of foam treatment were studied: 100 mL (n = 12) and 120 mL (n = 13); all animals were monitored for 3 hours or until death.
  
  
  RESULTS
  Foam treatment at both doses resulted in a significant survival benefit and reduction in hemorrhage rate relative to the control group. Median survival time was 135 minutes and 175 minutes for the 120-mL and 100-mL doses, compared with 32 minutes in the control group (p < 0.001 for both groups). Foam resulted in an immediate, persistent improvement in mean arterial pressure and a transient increase in intra-abdominal pressure. The median hemorrhage rate was 0.27 g/kg per minute in the 120-mL group and 0.23 g/kg per minute in the 100-mL group, compared with 1.4 g/kg per minute in the control group (p = 0.003 and 0.006, respectively, as compared with the control).
  
  
  CONCLUSIONS
  Self-expanding foam treatment significantly improves survival in an otherwise lethal, noncompressible, massive, arterial injury. This treatment may provide a prehospital intervention for control of noncompressible abdominal hemorrhage.
authors: From the Division of Trauma, Emergency Surgery and Surgical Critical Care (M.J.D., J.B., G.V., M.A.D., J.H., D.R.K.), Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston; and Arsenal Medical, Inc. (A.R., J.M., U.S.), Watertown, Massachusetts.
authors: Adam
authors: A
authors: Rago
authors: Michael J
authors: MJ
authors: Duggan
authors: John
authors: J
authors: Marini
authors: John
authors: J
authors: Beagle
authors: George
authors: G
authors: Velmahos
authors: Marc A
authors: MA
authors: De Moya
authors: Upma
authors: U
authors: Sharma
authors: John
authors: J
authors: Hwabejire
authors: David Richard
authors: DR
authors: King
mesh_terms: D000007:Abdominal Injuries / Q000401:mortality* / Q000628:therapy*; D000818:Animals; D062186:Arterial Pressure; D002302:Cardiac Output; D004195:Disease Models, Animal; D004867:Equipment Design; D058734:Exsanguination / Q000401:mortality* / Q000628:therapy; D006490:Hemostatics / Q000008:administration & dosage / Q000627:therapeutic use*; D007083:Iliac Artery / Q000293:injuries*; D053208:Kaplan-Meier Estimate; D011140:Polyurethanes / Q000008:administration & dosage* / Q000627:therapeutic use; D013552:Swine
chemical_list: D006490:Hemostatics; D011140:Polyurethanes