Modified rapid deployment hemostat bandage reduces blood loss and mortality in coagulopathic pigs with severe liver injury

Abstract

Background Hemostasis can be difficult to achieve after blunt abdominal trauma, particularly if the patient is coagulopathic. The U.S. Food and Drug Administration has recently approved the Rapid Deployment Hemostat (RDH) bandage (Marine Polymer Technologies, Cambridge, MA) as a treatment for external bleeding after extremity trauma. It has not been evaluated for internal bleeding. We tested whether the RDH bandage could achieve hemostasis when used as an adjunct to standard laparotomy pad packing after severe liver injury.Methods Anesthetized swine (n = 10, 35-45 kg) received an isovolemic 45% blood volume replacement with refrigerated Hextend (6% hetastarch). Core body temperature was maintained at 33° to 34°C with intra-abdominal ice packs. A hypocoagulopathic state was documented by thromboelastography (p < 0.001). At this point, a severe liver injury was induced by the avulsion of the left lateral hepatic lobe. Animals were randomized to standard abdominal packing (control) or packing plus RDH bandage. The abdomen was closed and the animal resuscitated with one unit of blood plus lactated Ringer's as needed to maintain a mean arterial pressure > 70 mm Hg. After 1 hour, the packing was removed, the abdomen was closed, and data were collected for an additional 2 hours.Results The RDH bandage reduced mortality, total blood loss, and total intravenous fluid requirements and increased survival time when used as an adjunct to standard abdominal packing after severe liver injury.Conclusion Further work in the clinical arena is warranted. © 2003 Lippincott Williams and Wilkins, Inc.