BACKGROUND: Improvements in early hemorrhage control could result in more favorable outcomes. Several advanced hemostatic dressings are available; however, none meets the ideal characteristics defined by the United States Army. We studied the effects of a new dextran polymer hemostatic dressing on survival, blood loss, and blood pressure in a swine model of severe liver injury. METHODS: We randomized 12 Yorkshire swine to treatment with either standard laparotomy pads or laparotomy pads coated with a dextran polymer (Bloxx). These dressings are visually identical, and investigators were not informed of the dressing assignment. We transected the left medial lobe of the liver in the anesthetized swine with a large knife, applied dressings immediately, and held pressure for 7 min. The animals received a weight-based maintenance crystalloid infusion without further resuscitation. Endpoints were blood loss, blood pressure, early mortality (120 min), and tissue histology. RESULTS: Baseline and pre-injury characteristics were similar between all animals. Three of six animals in the control group survived for 2 h while all six animals treated with Bloxx survived (P=0.05). Similarly, animals in the Bloxx group experienced less blood loss (10.4+/-8.8 mL/kg versus 28.3+/-13.0 mL/kg, P=0.025) and higher post-injury blood pressure than the control group. Bloxx was not associated with macroscopic or microscopic tissue damage. CONCLUSIONS: Bloxx is superior to standard laparotomy sponges in this model of lethal liver injury. Further study of this dressing is warranted to determine its potential for use in civilian and military trauma.
BACKGROUND: Improvements in early hemorrhage control could result in more favorable outcomes. Several advanced hemostatic dressings are available; however, none meets the ideal characteristics defined by the United States Army. We studied the effects of a new dextran polymer hemostatic dressing on survival, blood loss, and blood pressure in a swine model of severe liver injury. METHODS: We randomized 12 Yorkshire swine to treatment with either standard laparotomy pads or laparotomy pads coated with a dextran polymer (Bloxx). These dressings are visually identical, and investigators were not informed of the dressing assignment. We transected the left medial lobe of the liver in the anesthetized swine with a large knife, applied dressings immediately, and held pressure for 7 min. The animals received a weight-based maintenance crystalloid infusion without further resuscitation. Endpoints were blood loss, blood pressure, early mortality (120 min), and tissue histology. RESULTS: Baseline and pre-injury characteristics were similar between all animals. Three of six animals in the control group survived for 2 h while all six animals treated with Bloxx survived (P=0.05). Similarly, animals in the Bloxx group experienced less blood loss (10.4+/-8.8 mL/kg versus 28.3+/-13.0 mL/kg, P=0.025) and higher post-injury blood pressure than the control group. Bloxx was not associated with macroscopic or microscopic tissue damage. CONCLUSIONS: Bloxx is superior to standard laparotomy sponges in this model of lethal liver injury. Further study of this dressing is warranted to determine its potential for use in civilian and military trauma.
Authors: Thomas J Styslinger; Ning Zhang; Veer S Bhatt; Nicholas Pettit; Andre F Palmer; Peng G Wang Journal: J Am Chem Soc Date: 2012-04-21 Impact factor: 15.419