Testing of Modified Zeolite Hemostatic Dressings in a Large Animal Model of Lethal Groin Injury
- 1 December 2006
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in The Journal of Trauma and Acute Care Surgery
- Vol. 61 (6), 1312-1320
- https://doi.org/10.1097/01.ta.0000240597.42420.8f
Abstract
Background: We have previously identified a granular zeolite hemostat (ZH) as an effective agent for control of severe bleeding, and it is currently being used by the US troops in the battlefield. ZH causes an exothermic reaction on application, which theoretically can be decreased by altering its chemical composition or changing its physical properties. However, the effect of these alterations on the hemostatic efficacy is unknown. We tested modified zeolites and a chitosan based dressing against controls in a swine model of battlefield injury. Methods: A complex groin injury was created in 60 swine (40-55 kg). This included semi-transection of the proximal thigh (level of inguinal ligament), and complete division of the femoral artery and vein. After 3 minutes, the animals were assigned to (1) no dressing (ND), (2) standard dressing (SD), (3-5) SD + chemically modified ZHs, where calcium was substituted with sodium (Na), barium (Ba), or silver (Ag), respectively, (6) SD + physically modified ZH, where "beads" were packaged in a fabric bag, (7) SD + chitosan based dressing (CD). Resuscitation was started 15 minutes after application of dressing (500 mL of 6% hetastarch over 30 minutes). Survival for 180 minutes was the primary endpoint for this study. In addition, blood loss, wound temperatures, and histologic tissue damage were recorded. Results: Mortality in the group that was treated with the application of bagged ZH was 10% versus 100 % in the no dressing group and 50% in the SD group (p < 0.05 vs. ND and SD groups). The Na ZH group had a mortality rate of 43 %, whereas application of Ba and Ag substituted zeolites, and CD were associated with a mortality rate of 25%. Ionic substitution of zeolite decreased the in vivo temperature peak by 5 to 10 degrees C. No histologic evidence of tissue necrosis was noted in this experiment. Conclusions: The use of zeolite hemostat can control hemorrhage and dramatically reduce mortality from a lethal groin wound. Modifications of zeolite hemostat can decrease the exothermic reaction and attenuate tissue damage.Keywords
This publication has 23 references indexed in Scilit:
- Making Sense of the Preclinical Literature on Advanced Hemostatic ProductsThe Journal of Trauma and Acute Care Surgery, 2006
- Beyond the Purple Heart — Continuity of Care for the Wounded in IraqThe New England Journal of Medicine, 2005
- A U.S. Army Forward Surgical Team’s Experience in Operation Iraqi FreedomThe Journal of Trauma and Acute Care Surgery, 2004
- Advanced Hemostatic Dressing Development Program: Animal Model Selection Criteria and Results of a Study of Nine Hemostatic Dressings in a Model of Severe Large Venous Hemorrhage and Hepatic Injury in SwineThe Journal of Trauma and Acute Care Surgery, 2003
- Modified Rapid Deployment Hemostat Bandage Reduces Blood Loss and Mortality in Coagulopathic Pigs with Severe Liver InjuryThe Journal of Trauma and Acute Care Surgery, 2003
- Comparative Analysis of Hemostatic Agents in a Swine Model of Lethal Groin InjuryThe Journal of Trauma and Acute Care Surgery, 2003
- Battlefield Casualties Treated at Camp Rhino, Afghanistan: Lessons LearnedThe Journal of Trauma and Acute Care Surgery, 2003
- Comparison of 10 Different Hemostatic Dressings in an Aortic InjuryThe Journal of Trauma and Acute Care Surgery, 2003
- Effect of a Chitosan-Based Hemostatic Dressing on Blood Loss and Survival in a Model of Severe Venous Hemorrhage and Hepatic Injury in SwineThe Journal of Trauma and Acute Care Surgery, 2003