Arnaud Françoise, Teranishi Kohsuke, Tomori Toshiki, Carr Walter, McCarron Richard
Department of Resuscitative Medicine, Naval Medical Research Center, Silver Spring, MD 20910-7500, USA.
J Vasc Surg. 2009 Sep;50(3):632-9, 639.e1. doi: 10.1016/j.jvs.2009.06.010.
The use of mineral (clay) or biologic (chitosan) materials has improved the efficacy of dressings used in the bleeding control of noncompressible areas. A series of novel manufactured products already evaluated in a vascular transection model was further compared in a severe vascular puncture injury model.
Ten hemostatic dressings were tested in anesthetized Yorkshire swine hemorrhaged for 45 seconds in a femoral arterial puncture model. Application of these dressings was followed by 5 minutes of compression (about 175 mm Hg), and at 15 minutes, 500 mL resuscitation fluid (Hextand) was infused during a 30-minute period. The animals were monitored for a 3-hour experimental observation period. Primary outcomes were incidence of bleeding after dressing application and animal survival.
Blood loss was 18.8% +/- 5.2% estimated blood volume (EBV) after 45 seconds of free bleeding. Relative performance of dressings is characterized as groups of dressings that performed similarly. Recurrence of bleeding after application was observed with most dressings and was lower with Woundstat, Celox, X-Sponge, and ACS+ (35% +/- 49%) compared with FP-21, Hemcon, Chitoflex, and Bloodstop (79% +/- 43%; P < .01). Blood loss after treatment was 25.3% +/- 18.4% EBV for the top four dressings and 53.0% +/- 18.4% EBV for the bottom four (P < .05). Survival was higher for top four vs bottom four dressings (78% +/- 12% vs 25% +/- 0%, respectively; P < .01). Overall performance of these dressings according to survival, incidence of bleeding, and post-treatment blood loss, yielded similar ranking as with a previously tested transection injury model.
The findings indicated that the efficacy of Woundstat, Celox, X-Sponge, and ACS+ were similar and superior in improving survival, hemostasis, and maintenance of mean arterial pressure in an actively bleeding wound caused in this severe vascular injury model.
使用矿物（粘土）或生物（壳聚糖）材料已提高了用于不可压缩区域出血控制的敷料的功效。在血管横断模型中已评估的一系列新型制成品在严重血管穿刺损伤模型中进行了进一步比较。
在股动脉穿刺模型中，对10种止血敷料在麻醉的约克郡猪中进行测试，使其出血45秒。应用这些敷料后进行5分钟的压迫（约175毫米汞柱），并在15分钟时，在30分钟内输注500毫升复苏液（Hextand）。对动物进行3小时的实验观察期。主要结局为敷料应用后出血发生率和动物存活率。
自由出血45秒后，失血量为估计血容量（EBV）的18.8%±5.2%。敷料的相对性能以表现相似的敷料组来表征。大多数敷料应用后观察到出血复发，与FP-21、Hemcon、Chitoflex和Bloodstop（79%±43%）相比，Woundstat、Celox、X-Sponge和ACS+（35%±49%）的出血复发率较低（P<.01）。前四种敷料治疗后的失血量为EBV的25.3%±18.4%，后四种为53.0%±18.4%（P<.05）。前四种敷料的存活率高于后四种（分别为78%±12%和25%±0%；P<.01）。根据存活率、出血发生率和治疗后失血量，这些敷料的总体性能产生了与先前测试的横断损伤模型相似的排名。
研究结果表明，在该严重血管损伤模型中造成的活动性出血伤口中，Woundstat、Celox、X-Sponge和ACS+在提高存活率、止血和维持平均动脉压方面的功效相似且更优。
