title: Hydrophobically modified chitosan gauze: a novel topical hemostat.
abstract: Currently, the standard of care for treating severe hemorrhage in a military setting is Combat Gauze (CG). Previous work has shown that hydrophobically modified chitosan (hm-C) has significant hemostatic capability relative to its native chitosan counterpart. This work aims to evaluate gauze coated in hm-C relative to CG as well as ChitoGauze (ChG) in a lethal in vivo hemorrhage model.
  
  
  
  Twelve Yorkshire swine were randomized to receive either hm-C gauze (n = 4), ChG (n = 4), or CG (n = 4). A standard hemorrhage model was used in which animals underwent a splenectomy before a 6-mm punch arterial puncture of the femoral artery. Thirty seconds of free bleeding was allowed before dressings were applied and compressed for 3 min. Baseline mean arterial pressure was preserved via fluid resuscitation. Experiments were conducted for 3 h after which any surviving animal was euthanized.
  
  
  
  hm-C gauze was found to be at least equivalent to both CG and ChG in terms of overall survival (100% versus 75%), number of dressing used (6 versus 7), and duration of hemostasis (3 h versus 2.25 h). Total post-treatment blood loss was lower in the hm-C gauze treatment group (4.7 mL/kg) when compared to CG (13.4 mL/kg) and ChG (12.1 mL/kg) groups.
  
  
  
  hm-C gauze outperformed both CG and ChG in a lethal hemorrhage model but without statistical significance for key endpoints. Future comparison of hm-C gauze to CG and ChG will be performed on a hypothermic, coagulopathic model that should allow for outcome significance to be differentiated under small treatment groups.
authors.affiliation: Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland, School of Medicine, Baltimore, Maryland.
authors.forename: Apurva
authors.initials: A
authors.lastname: Chaturvedi
authors.affiliation: Fischell Department of Bioengineering, University of Maryland, College Park, Maryland.
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Dowling
authors.affiliation: Department of Chemical & Biomolecular Engineering, University of Maryland, College Park, Maryland.
authors.forename: John P
authors.initials: JP
authors.lastname: Gustin
authors.affiliation: Fischell Department of Bioengineering, University of Maryland, College Park, Maryland.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Scalea
authors.affiliation: Fischell Department of Bioengineering, University of Maryland, College Park, Maryland; Department of Chemical & Biomolecular Engineering, University of Maryland, College Park, Maryland.
authors.forename: Srinivasa R
authors.initials: SR
authors.lastname: Raghavan
authors.affiliation: Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland, School of Medicine, Baltimore, Maryland.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Pasley
authors.affiliation: Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland, School of Medicine, Baltimore, Maryland. Electronic address: mayur.narayan@utsouthwestern.edu.
authors.forename: Mayur
authors.initials: M
authors.lastname: Narayan
mesh_terms: D000287:Administration, Topical; D000818:Animals; D001458:Bandages; D048271:Chitosan / Q000008:administration & dosage* / Q000737:chemistry / Q000627:therapeutic use; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy*; D006489:Hemostatic Techniques / Q000295:instrumentation*; D006490:Hemostatics / Q000008:administration & dosage* / Q000737:chemistry / Q000627:therapeutic use; D057927:Hydrophobic and Hydrophilic Interactions; D011897:Random Allocation; D013552:Swine; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000150:complications*
chemical_list: D006490:Hemostatics; D048271:Chitosan
keywords: Hemostasis; Hemostatic gauze; Hm-chitosan; Modified chitosan gauze; Trauma