A novel sponge-based wound stasis dressing to treat lethal noncompressible hemorrhage

Genevieve R. Mueller, Teresa J. Pineda, Hua Xie, Jeffrey S. Teach, Andrew D. Barofsky, James R. Schmid, Kenton Gregory

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Background: Noncompressible hemorrhage is the leading cause of preventable death caused by hemorrhage on the battlefield. Currently, there are no hemostatic agents with the ability to control noncompressible hemorrhage. A wound stasis dressing based upon rapidly expanding cellulose minisponges (MS) was developed and tested in a lethal noncompressible model in swine, by fully transecting subclavian artery and vein. MS were compared with conventional hemostasis dressings, Combat Gauze (CG), in a randomized comparison. Methods: Sixteen 40-kg swine underwent transection of the subclavian artery and vein through a 4.5-cm aperture. After 30-second free bleeding, randomly selected MS or CG (n = 8 per group) were administered by an independent medical officer. The wound cavity was filled with either MS + no external pressure or one CG + one KERLIX gauze with 3 minutes of external pressure. One reapplication was allowed for CG. Mean arterial pressure was maintained at 60 mm Hg with 500-mL Hextend and lactated Ringer's solution intravenously administered up to a maximum of 10-L until study termination at 1 hour. Results: Mean pretreatment blood loss was similar for MS (719 mL) and CG (702 mL). Primary end points, namely, hemostasis at 4 minutes (MS, 75%; CG, 25%; p = 0.13), hemostasis at 60 minutes (MS, 100%; CG, 25%; p = 0.007), and survival at 60 minutes (MS, 100%; CG, 37.5%; p = 0.026), were improved with MS as were secondary end points, namely, total blood loss (MS, 118 mL; CG 1,242 mL; p = 0.021) and length of application time (MS, 25 seconds; CG, 420 seconds; p = 0.004). Conclusion: The use of MS is a novel approach for the rapid, simple treatment of severe noncompressible hemorrhage, which provided statistically significant improvement in hemostasis and survival 60 minutes after injury and a large reduction in blood loss, resuscitation fluid requirement, and medic treatment time compared with conventional hemorrhage control dressings in a swine model.

Original languageEnglish (US)
JournalJournal of Trauma and Acute Care Surgery
Volume73
Issue number2 SUPPL. 1
DOIs
StatePublished - Aug 2012

Fingerprint

Porifera
Bandages
Hemorrhage
Hemostasis
Wounds and Injuries
Subclavian Vein
Subclavian Artery
Swine
Pressure
Hemostatics
Resuscitation
Cellulose
Cause of Death
Arterial Pressure
Therapeutics

Keywords

  • combat gauze
  • Hemorrhage
  • minisponge
  • noncompressible

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

A novel sponge-based wound stasis dressing to treat lethal noncompressible hemorrhage. / Mueller, Genevieve R.; Pineda, Teresa J.; Xie, Hua; Teach, Jeffrey S.; Barofsky, Andrew D.; Schmid, James R.; Gregory, Kenton.

In: Journal of Trauma and Acute Care Surgery, Vol. 73, No. 2 SUPPL. 1, 08.2012.

Research output: Contribution to journalArticle

Mueller, Genevieve R. ; Pineda, Teresa J. ; Xie, Hua ; Teach, Jeffrey S. ; Barofsky, Andrew D. ; Schmid, James R. ; Gregory, Kenton. / A novel sponge-based wound stasis dressing to treat lethal noncompressible hemorrhage. In: Journal of Trauma and Acute Care Surgery. 2012 ; Vol. 73, No. 2 SUPPL. 1.
@article{6fe57ff850ae4c73a3d5350df41cd2ba,
title = "A novel sponge-based wound stasis dressing to treat lethal noncompressible hemorrhage",
abstract = "Background: Noncompressible hemorrhage is the leading cause of preventable death caused by hemorrhage on the battlefield. Currently, there are no hemostatic agents with the ability to control noncompressible hemorrhage. A wound stasis dressing based upon rapidly expanding cellulose minisponges (MS) was developed and tested in a lethal noncompressible model in swine, by fully transecting subclavian artery and vein. MS were compared with conventional hemostasis dressings, Combat Gauze (CG), in a randomized comparison. Methods: Sixteen 40-kg swine underwent transection of the subclavian artery and vein through a 4.5-cm aperture. After 30-second free bleeding, randomly selected MS or CG (n = 8 per group) were administered by an independent medical officer. The wound cavity was filled with either MS + no external pressure or one CG + one KERLIX gauze with 3 minutes of external pressure. One reapplication was allowed for CG. Mean arterial pressure was maintained at 60 mm Hg with 500-mL Hextend and lactated Ringer's solution intravenously administered up to a maximum of 10-L until study termination at 1 hour. Results: Mean pretreatment blood loss was similar for MS (719 mL) and CG (702 mL). Primary end points, namely, hemostasis at 4 minutes (MS, 75{\%}; CG, 25{\%}; p = 0.13), hemostasis at 60 minutes (MS, 100{\%}; CG, 25{\%}; p = 0.007), and survival at 60 minutes (MS, 100{\%}; CG, 37.5{\%}; p = 0.026), were improved with MS as were secondary end points, namely, total blood loss (MS, 118 mL; CG 1,242 mL; p = 0.021) and length of application time (MS, 25 seconds; CG, 420 seconds; p = 0.004). Conclusion: The use of MS is a novel approach for the rapid, simple treatment of severe noncompressible hemorrhage, which provided statistically significant improvement in hemostasis and survival 60 minutes after injury and a large reduction in blood loss, resuscitation fluid requirement, and medic treatment time compared with conventional hemorrhage control dressings in a swine model.",
keywords = "combat gauze, Hemorrhage, minisponge, noncompressible",
author = "Mueller, {Genevieve R.} and Pineda, {Teresa J.} and Hua Xie and Teach, {Jeffrey S.} and Barofsky, {Andrew D.} and Schmid, {James R.} and Kenton Gregory",
year = "2012",
month = "8",
doi = "10.1097/TA.0b013e3182617c3c",
language = "English (US)",
volume = "73",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "2 SUPPL. 1",

}

TY - JOUR

T1 - A novel sponge-based wound stasis dressing to treat lethal noncompressible hemorrhage

AU - Mueller, Genevieve R.

AU - Pineda, Teresa J.

AU - Xie, Hua

AU - Teach, Jeffrey S.

AU - Barofsky, Andrew D.

AU - Schmid, James R.

AU - Gregory, Kenton

PY - 2012/8

Y1 - 2012/8

N2 - Background: Noncompressible hemorrhage is the leading cause of preventable death caused by hemorrhage on the battlefield. Currently, there are no hemostatic agents with the ability to control noncompressible hemorrhage. A wound stasis dressing based upon rapidly expanding cellulose minisponges (MS) was developed and tested in a lethal noncompressible model in swine, by fully transecting subclavian artery and vein. MS were compared with conventional hemostasis dressings, Combat Gauze (CG), in a randomized comparison. Methods: Sixteen 40-kg swine underwent transection of the subclavian artery and vein through a 4.5-cm aperture. After 30-second free bleeding, randomly selected MS or CG (n = 8 per group) were administered by an independent medical officer. The wound cavity was filled with either MS + no external pressure or one CG + one KERLIX gauze with 3 minutes of external pressure. One reapplication was allowed for CG. Mean arterial pressure was maintained at 60 mm Hg with 500-mL Hextend and lactated Ringer's solution intravenously administered up to a maximum of 10-L until study termination at 1 hour. Results: Mean pretreatment blood loss was similar for MS (719 mL) and CG (702 mL). Primary end points, namely, hemostasis at 4 minutes (MS, 75%; CG, 25%; p = 0.13), hemostasis at 60 minutes (MS, 100%; CG, 25%; p = 0.007), and survival at 60 minutes (MS, 100%; CG, 37.5%; p = 0.026), were improved with MS as were secondary end points, namely, total blood loss (MS, 118 mL; CG 1,242 mL; p = 0.021) and length of application time (MS, 25 seconds; CG, 420 seconds; p = 0.004). Conclusion: The use of MS is a novel approach for the rapid, simple treatment of severe noncompressible hemorrhage, which provided statistically significant improvement in hemostasis and survival 60 minutes after injury and a large reduction in blood loss, resuscitation fluid requirement, and medic treatment time compared with conventional hemorrhage control dressings in a swine model.

AB - Background: Noncompressible hemorrhage is the leading cause of preventable death caused by hemorrhage on the battlefield. Currently, there are no hemostatic agents with the ability to control noncompressible hemorrhage. A wound stasis dressing based upon rapidly expanding cellulose minisponges (MS) was developed and tested in a lethal noncompressible model in swine, by fully transecting subclavian artery and vein. MS were compared with conventional hemostasis dressings, Combat Gauze (CG), in a randomized comparison. Methods: Sixteen 40-kg swine underwent transection of the subclavian artery and vein through a 4.5-cm aperture. After 30-second free bleeding, randomly selected MS or CG (n = 8 per group) were administered by an independent medical officer. The wound cavity was filled with either MS + no external pressure or one CG + one KERLIX gauze with 3 minutes of external pressure. One reapplication was allowed for CG. Mean arterial pressure was maintained at 60 mm Hg with 500-mL Hextend and lactated Ringer's solution intravenously administered up to a maximum of 10-L until study termination at 1 hour. Results: Mean pretreatment blood loss was similar for MS (719 mL) and CG (702 mL). Primary end points, namely, hemostasis at 4 minutes (MS, 75%; CG, 25%; p = 0.13), hemostasis at 60 minutes (MS, 100%; CG, 25%; p = 0.007), and survival at 60 minutes (MS, 100%; CG, 37.5%; p = 0.026), were improved with MS as were secondary end points, namely, total blood loss (MS, 118 mL; CG 1,242 mL; p = 0.021) and length of application time (MS, 25 seconds; CG, 420 seconds; p = 0.004). Conclusion: The use of MS is a novel approach for the rapid, simple treatment of severe noncompressible hemorrhage, which provided statistically significant improvement in hemostasis and survival 60 minutes after injury and a large reduction in blood loss, resuscitation fluid requirement, and medic treatment time compared with conventional hemorrhage control dressings in a swine model.

KW - combat gauze

KW - Hemorrhage

KW - minisponge

KW - noncompressible

UR - http://www.scopus.com/inward/record.url?scp=84864628538&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84864628538&partnerID=8YFLogxK

U2 - 10.1097/TA.0b013e3182617c3c

DO - 10.1097/TA.0b013e3182617c3c

M3 - Article

VL - 73

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 2 SUPPL. 1

ER -