Baker Jennifer E, Goodman Michael D, Makley Amy T, Stevens-Topie Sabre M, Veile Rosalie A, Mahoney Eric J, Heyl Judy R, Cox Daniel B, Pritts Timothy A, Athota Krishna P
Institute for Military Medicine, Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, ML 0558, Cincinnati, OH.
Center for Sustainment of Trauma and Readiness Skills, United States Air Force, University of Cincinnati, 231 Albert Sabin Way, ML 0558, Cincinnati, OH.
Mil Med. 2019 Mar 1;184(3-4):e290-e296. doi: 10.1093/milmed/usy168.
Acute hemorrhage remains the leading cause of death in potentially survivable injuries. The use of topical hemostatic agents has increased over the last two decades with the evolution of damage control surgery. By 2008, the military widely adopted Combat Gauze as the hemostatic dressing of choice for compressible hemorrhage. The goal of this study was to compare the performance of a novel fibrin sealant patch to Combat Gauze in two clinically relevant models of hemorrhage.
Yorkshire swine underwent unilateral femoral artery puncture or a grade V liver laceration with timed free bleeding then received either the fibrin patch or Combat Gauze packing with 3 minutes of standardized pressure. Animals were then resuscitated to maintain a mean arterial pressure of 60 mmHg for 4 hours. Hemostasis, blood loss, resuscitation volume, survival, vessel patency, and hematologic parameters were evaluated.
Hemostasis was equivalent in both groups after hepatic and vascular injury. Survival was 80% in the fibrin patch vascular injury group and 100% in all other groups. Hematologic parameters were not significantly different between treatment groups. Femoral artery patency was 80% in both groups after vascular injury. With simulated ambulation after vessel injury, 60% of the Combat Gauze group and 80% of the fibrin patch group remained hemostatic (p > 0.05). In simulated re-exploration with packing removal, all animals rebled after hemostatic product removal.
There was no significant difference in hemostasis between a novel fibrin patch and Combat Gauze after extremity arterial or hepatic injury. This novel fibrin patch may have a clinical advantage over the Combat Gauze, as it can be left in the body, thereby limiting the potential need for reoperation.
急性出血仍然是潜在可存活创伤导致死亡的主要原因。在过去二十年中，随着损伤控制手术的发展，局部止血剂的使用有所增加。到2008年，军队广泛采用战斗止血纱布作为可压缩性出血的首选止血敷料。本研究的目的是在两种临床相关的出血模型中比较一种新型纤维蛋白密封剂贴片与战斗止血纱布的性能。
约克郡猪接受单侧股动脉穿刺或V级肝裂伤并定时自由出血，然后在3分钟标准化压力下接受纤维蛋白贴片或战斗止血纱布填塞。然后对动物进行复苏，使其平均动脉压维持在60 mmHg达4小时。评估止血情况、失血量、复苏容量、存活率、血管通畅情况和血液学参数。
肝损伤和血管损伤后两组的止血效果相当。纤维蛋白贴片血管损伤组的存活率为80%，所有其他组为100%。各治疗组之间的血液学参数无显著差异。血管损伤后两组股动脉通畅率均为80%。血管损伤后模拟行走时，战斗止血纱布组60%的动物和纤维蛋白贴片组80%的动物保持止血状态（p>0.05）。在模拟移除填塞物的再次探查中，所有动物在移除止血产品后再次出血。
新型纤维蛋白贴片与战斗止血纱布在肢体动脉或肝损伤后的止血效果无显著差异。这种新型纤维蛋白贴片可能比战斗止血纱布具有临床优势，因为它可以留在体内，从而减少再次手术的潜在需求。
