MSS13: EARLY HEMORRHAGE CONTROL WITH NEXT GENERATION TOPICAL HEMOSTATIC AGENTS
Adelle M Dagher, DO1; Lauren M Heyda, MD1; John A Mares2; Justin D Hutzler2; Jason S Radowsky, MD1; David M Burmeister, PhD2; Brandon Propper, MD1; 1Walter Reed National Military Medical Center; 2Uniformed Services University
Objectives: The majority of preventable deaths from combat-related injury are associated with hemorrhage and occur in the prehospital phase. Non-compressible truncal and junctional hemorrhage remains a challenge in trauma care, especially with prolonged evacuation time. We sought to evaluate the efficacy of commercial topical hemostatic agents in an uncontrolled junctional hemorrhage swine model under coagulopathic conditions. We examined the efficacy of each agent and differences based upon applicator experience.
Methods: Thirty Yorkshire swine were equally randomized to a 5 groups of hemostatic agents, including Combat Gauze (CG), which served as the control, Celox Rapid (CR), ChitoSAM 100 (CS), EVARREST® Fibrin Sealant Patch (EP), and X-Stat 30 (XS). Each group was further split into experienced applicators (10 or more previous applications of any hemostatic agent) and non-experienced (less than 5 prior applications) for placement of the hemostatic agent. After anesthetic induction, swine underwent bilateral carotid cannulation and common femoral artery exposure. Baseline hemodynamics and laboratory evaluation was completed, followed by a 50% hemodilution to induce a coagulopathic state. A 4-5mm arteriotomy was made and was bled for 30 seconds. The hemostatic agent was applied according to manufacturer’s instructions. A total of 3 applications was allowed for continued or recurrent bleeding, after which animals were monitored for 60 minutes in an ICU setting. Angiography was completed to evaluate for extravasation, thrombosis, and distal perfusion. The limb was ranged to assess for re-bleeding and clot stability.
Results: There was no difference in the number of gauze applications required to obtain hemostasis between non-experienced and experienced applicators except for ChitoSAM, for which the novice group required a mean of 2.3 applications compared to 1 (p=0.0104). No difference in failure rate among the devices (0% CG, CS 33%, CR 17%, EP 17% , XS 33%) or failure rate by user experience was observed. In surviving animals, no difference in extravasation or perfusion was demonstrated on angiogram and while distal occlusion occurred more frequently in the CG (100%), CS (75%) and XS (75%) groups, this difference was not significant. There was no significant difference in survival by specific device.
Conclusion: In this model of uncontrolled junctional hemorrhage, the 5 hemostatic agents tested performed with similar efficacy. No difference in ability to attain hemostasis, device failure, or survival was demonstrated across experience level. All tested dressings show promise for early hemorrhage control in the pre-hospital setting.