Hemostatic Agents for Control of Intracavitary Non-Compressible Hemorrhage: An Overview of Current Results1


The majority (~80%) of hemorrhagic deaths on the battlefield are due to intracavitary hemorrhage that is not accessible for direct compression and cannot be treated with externally applied hemostatic agents. In an attempt to address this issue, a project was initiated to evaluate the efficacy of different hemostatic products when introduced into a closed hemorrhaging body cavity. Two thrombin-based hemostatic agents have been tested thus far in rat and rabbit models. In the initial phase, these agents were tested by direct and immediate application over severe parenchymal injury without compression in open-abdomen models. In the second phase of the project, the hemostatic agents were infused 5 minutes after a liver injury in closed-abdomen injury models. In the phase 1 open abdomen studies, both hemostatic agents decreased blood loss when compared with placebo-treated control animals. This decreased blood loss corresponded to an increase in survival rates that was not, however, statistically significant. In the phase 2 closed abdomen study neither hemostatic agent was able to produce a significant change in blood loss or survival rates when compared to control animals. The hemostatic properties of both hemostatic agents involve binding with injured tissues. Such characteristics require contact of these agents with damaged, bleeding tissues. In the closed abdomen model, contact is made difficult by ongoing hemorrhage and pooled blood. The failure of both products to demonstrate efficacy may also have been due to model design. In the severe liver injury model, bleeding is most severe in the first few minutes after the injury that unless treated promptly the consequences cannot be reversed by later interventions. Additional studies in more appropriate models with alternative hemostatic agents will further evaluate the potential for intracavitary approach to treat the noncompressible hemorrhage. 1.0 INTRODUCTION Hemorrhage is the greatest threat to survival in the first 24 hours following traumatic injury [1]. It accounts for nearly 50% of all deaths on the battlefield and 39% of civilian trauma deaths [2-5], most of which occur before patients reach the hospital [6-7]. Traditional methods available to pre-hospital personnel for controlling hemorrhage, such as applying tourniquets or pressure dressings, or clamping, are practical for extremity or superficial truncal wounds. However, these types of wounds account for only 10% of hemorrhage-related combat deaths and even fewer hemorrhage-related civilian deaths [8-9]. The majority of hemorrhagic deaths 1 The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense. Paper presented at the RTO HFM Symposium on “Combat Casualty Care in Ground Based Tactical Situations: Trauma Technology and Emergency Medical Procedures”, held in St. Pete Beach, USA, 16-18 August 2004, and published in RTO-MP-HFM-109. Report Documentation Page Form Approved OMB No. 0704-0188 Public reporting burden for the collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to a penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. 1. REPORT DATE 01 SEP 2004 2. REPORT TYPE N/A 3. DATES COVERED 4. TITLE AND SUBTITLE Hemostatic Agents for Control of Intracavitary Non-Compressible Hemorrhage: An Overview of Current Results 5a. CONTRACT NUMBER


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