Comparison of a new hemostatic agent to current combat hemostatic agents in a Swine model of lethal extremity arterial hemorrhage.
ABSTRACT Gaining hemostatic control of lethal vascular injuries sustained in combat using topical agents remains a challenge. Recent animal testing using a lethal arterial injury model has demonstrated that QuikClot zeolite granules (QCG) and the HemCon chitosan bandage (HC) are not capable of providing hemostasis and improving survival over the Army gauze field bandage (AFB). We have developed a new hemostatic agent consisting of a granular combination of a smectite mineral and a polymer (WoundStat) capable of producing hemostasis in the face of high-pressure arterial bleeding. We compared the performance of WoundStat (WS) to QCG, HC, AFB, and the new QuikClot zeolite Advance Clotting Sponge (ACS) in a lethal vascular injury model.
Hemostatic agents were tested using a lethal femoral artery vascular injury model. Twenty-five (5 per group) male swine (42 kg +/- 3 kg) were anesthetized, instrumented, and splenectomized. A lethal femoral artery injury was produced by creating a 6-mm arteriotomy in the vessel. After 45 seconds of hemorrhage, animals were randomized to be treated with AFB (control group), HC, QCG, ACS, or WS. Pressure (200 mm Hg) was applied over the product in the wound for 3 minutes. A second application and 3 additional minutes of pressure was provided if hemostasis was not achieved. Fluid resuscitation was begun at the time of application with 500 mL of Hextend, followed by lactated Ringer's solution at 100 mL/min to achieve and maintain a postapplication mean arterial blood pressure of 65 mm Hg. Animals were observed for 180 minutes or until death. Primary endpoints were survival, survival time, post-treatment blood loss, and amount of resuscitation fluid.
All animals treated with WS survived to 180 minutes and required only a single application. No animal in the AFB, QCG, or ACS group survived. One animal in the HC group survived. Survival (p < 0.05) and survival times (p < 0.0001) for WS animals were significantly greater than for all other groups. No significant difference in survival or survival time existed between the AFB, QCG, ACS, or HC groups. Post-treatment blood loss (p = 0.0099) and postresuscitation fluid volume (p = 0.006) was significantly less for animals treated with WS than for all other groups. No significant difference in these parameters existed between the AFB, QCG, ACS, and HC groups.
WS was superior to the other hemostatic agents tested in this study of lethal arterial vascular injury. Additional study is warranted on this agent to determine its potential for use in combat and civilian trauma.
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- "Furthermore, significant blood loss predisposes individuals to hypothermia, coagulopathy, infection , acidosis and multiple organ failure. Therefore, early control of hemorrhage is essential for initial survival and also for optimal recovery . The US military's Committee on Tactical Combat Casualty Care (CTCCC) is the group responsible for developing guidelines for the management of wounded military personnel. "
ABSTRACT: Hemorrhage is the leading cause of death from trauma. Intravenous (IV) fluid resuscitation in these patients may cause hemodilution and secondary hemorrhage. In addition, hypothermia may interfere with coagulation. The purposes of this study were to compare the effectiveness QuikClot Combat Gauze (QCG) to a control group on hemorrhage in a hemodiluted, hypothermic model, and to determine the effects of IV volume resuscitation on rebleeding. This was a prospective, between subjects, experimental design. Yorkshire swine were randomly assigned to two groups: QCG (n = 13) or control (n = 13). The subjects were anesthetized. Hypothermia (temperature of ≤34.0 °C) was induced; 30% of their blood volume was exsanguinated. A 3:1 replacement of Lactated Ringer's was administered to dilute the remaining blood. The femoral artery and vein were transected. After 1 min of uncontrolled hemorrhage, QCG was placed into the wound followed by standard wound packing. The control group underwent the same procedures without QCG. After 5 min of manual pressure, a pressure dressing was applied. Following 30 min, the dressings were removed, and blood loss was calculated. For subjects achieving hemostasis, up to 5 L of IV fluid was administered or until bleeding occurred, which was defined as >2% total blood volume. The QCG had significantly less hemorrhage than the control (QCG = 30 ± 99 mL; control = 404 ± 406 mL) (p = .004). Further, the QCG group was able to tolerate more resuscitation fluid before hemorrhage (QCG = 4615 ± 1386 mL; control = 846 ± 1836) (p = .000).06/2014; 3(2):21–25. DOI:10.1016/j.amsu.2014.03.001
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- "Thus, the ability of chitosan to initiate coagulation is related to the percent of deacetylated chitosan. Chitosan is among a number of currently deployed haemostatic agents used within the armed services to treat hemorrhaging wounds, and has recently been contrasted with other materials for its efficacy as an advanced haemostatic product (Pusateri et al. 2006; Ward et al. 2007). Chitosan-based haemostatic products have also been compared with more highly ordered crystalline structures of glycosaminoglycans containing N-acetyl-glucosamine (Favuzza and Hechman 2004) in an attempt to optimize the charge to carbohydrate activity component. "
ABSTRACT: Recent developments in cellulose wound dressings targeted to different stages of wound healing have been based on structural and charge modifications that function to modulate events in the complex inflammatory and hemostatic phases of wound healing. Hemostasis and inflammation comprise two overlapping but distinct phases of wound healing wherein different dressing material properties are required to bring pathological events under control when they present as a result of trauma or chronic wounds. Thus, we have designed cellulose wound dressings with properties that function through modified fiber surface properties to lower protease levels in the chronic wound and promote clotting in hemorrhaging wounds. With this in mind three finishing chemistries utilizing traditional pad-dry-cure approaches were explored for their potential to confer charged properties to cotton dressings. Cellulose dressings designed to remove cationic serine proteases from highly exudative chronic wounds were created to present negatively charged fibers as an ion exchange mechanism of protease-lowering. Phosphorylated cotton and polycarboxylic acid crosslinked cotton were prepared to examine their ability to remove human neutrophil elastase (HNE) from surrogate wound fluid. A cellulose phosphorylation reaction utilizing sodium hexametaphosphate: urea was explored to optimize cellulose phosphorylation as a function of HNE sequestration efficacy. Acid catalyzed cross linking of cellulose with butane-tetracarboxylic acid also resulted in a negatively charged dressing that removed HNE from solution more effectively than phosphorylated cellulose. Collagenase sequestration was also assessed with phosphorylated cellulose and polycarboxylic acid cross linked cellulose derivatives. Butanetetracarboxylic acid and phosphorylated cellulose functioned to remove collagenase from solution most effectively. Cellulose dressings designed to accelerate thrombosis and aggregation of blood platelets were prepared with a view to examining derivatized cotton fibers bearing a net positive charge to promote hemostasis. Cellulose and chitosan dressings bearing an aminoglucan functionality were created by grafting chitosan on cotton and preparing aminized cotton. The preparation of chitosan-grafted cotton dressings was completed with a citric acid grafting onto cellulose. Aminized cotton was functionalized as an ethylamino-ether cellulose derivative. The chitosan-grafted and aminized cotton demonstrated a dose response gelling of citrated sheep blood.Cellulose 10/2009; 16(5). DOI:10.1007/s10570-009-9302-4 · 3.03 Impact Factor
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ABSTRACT: For high-resolution radar, target recognition is performed by using one-dimensional range profile. In this method, a radar target is described as composed of several kinds of scattering centers with different geometric shapes and structures. However, one-dimensional range profile is so extremely sensitive to aspect angle that a useful target recognition procedure is very unlikely to evolve from it. A novel idea is to use polarimetric range profile understanding technique to improve the recognition performance. In this paper, a study is performed on the fractal characterization of one-dimensional range profiles of high-resolution polarimetric radar targets at four kinds of polarimetric states (HH, HV, VH, VV), and a new concept of the fractal matrix is proposedAerospace and Electronics Conference, 1996. NAECON 1996., Proceedings of the IEEE 1996 National; 06/1996