Topical Dressings

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J Trauma. 2003 Sep;55(3):518-26.

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 Swine.

Pusateri AE, Modrow HE, RA, Holcomb JB, Hess JR, Mosebar RH, Reid TJ,

JH, Goodwin CW Jr, Fitzpatrick GM, McManus AT, Zolock DT, Sondeen JL,

Cornum RL, ez RS.

US Army Institute of Surgical Research, Fort Sam Houston, TX 78234-6315,

USA. anthony.pusateri@...

BACKGROUND: An advanced hemostatic dressing is needed to augment current

methods for the control of life-threatening hemorrhage. A systematic

approach to the study of dressings is described. We studied the effects of

nine hemostatic dressings on blood loss using a model of severe venous

hemorrhage and hepatic injury in swine. METHODS: Swine were treated using

one of nine hemostatic dressings. Dressings used the following primary

active ingredients: microfibrillar collagen, oxidized cellulose, thrombin,

fibrinogen, propyl gallate, aluminum sulfate, and fully acetylated

poly-N-acetyl glucosamine. Standardized liver injuries were induced,

dressings were applied, and resuscitation was initiated. Blood loss,

hemostasis, and 60-minute survival were quantified. RESULTS: The American

Red Cross hemostatic dressing (fibrinogen and thrombin) reduced (p < 0.01)

posttreatment blood loss (366 mL; 95% confidence interval, 175-762 mL) and

increased (p < 0.05) the percentage of animals in which hemostasis was

attained (73%), compared with gauze controls (2,973 mL; 95% confidence

interval, 1,414-6,102 mL and 0%, respectively). No other dressing was

effective. The number of vessels lacerated was positively related to

pretreatment blood loss and negatively related to hemostasis. CONCLUSION:

The hemorrhage model allowed differentiation among topical hemostatic agents

for severe hemorrhage. The American Red Cross hemostatic dressing was

effective and warrants further development.