Objective: Chitosan dressings have been shown to be effective in improving survival of severe parenchymal injuries in an animal model and in treating prehospital combat casualties. Our goal was to test the efficacy of chitosan acetate dressings in providing durable hemostasis in a high-flow arterial wound model.
Methods: A proximal arterial injury was created with 2.7-mm vascular punches in both femoral arteries of fourteen anesthetized swine. By using a crossover design, 48-ply gauze (48PG) or a chitosan dressing (HC) was applied with pressure to the injury for 3 minutes and then released. If hemostasis was not maintained for 30 minutes, a second identical attempt was made by using the same dressing type. If hemostasis was still not achieved, the dressing was considered an acute failure and the alternate dressing type was applied. If failure of hemostasis occurred between 30 and 240 minutes after application, the dressing was considered a chronic failure and the artery was ligated.
Results: All 25/25 (100%) of the HC tests and 3/14 (21%) of the 48PG maintained hemostasis for 30 minutes. At 240 minutes, 21/25 (84%) of the HC tests and 1/14 (7%) of the 48PG maintained hemostasis. Statistical analysis by Fischer's exact test shows a significant (p < 0.001) difference in hemostatic efficacy between the 48PG and HC groups in this model, both at 30 minutes and at 240 minutes.
Conclusion: Chitosan acetate hemorrhage control dressings provided superior hemostasis to 48 ply gauze in high inguinal femoral arterial injuries. Chitosan-based dressings may provide prehospital treatment options for hemostasis in patients with severe hemorrhagic arterial injuries.