Self-expanding foam improves survival following a lethal, exsanguinating iliac artery injury

J Trauma Acute Care Surg. 2014 Jul;77(1):73-7. doi: 10.1097/TA.0000000000000263.

Abstract

Background: Noncompressible abdominal bleeding is a significant cause of preventable death on the battlefield and in the civilian setting, with no effective therapies available at point of injury. We previously reported that a self-expanding polyurethane foam significantly improved survival in a lethal hepatoportal injury model of massive venous hemorrhage. In this study, we hypothesized that foam treatment could improve survival in a lethal iliac artery injury model in noncoagulopathic swine.

Methods: In swine with a closed abdomen, an iliac artery transection was created, resulting in massive noncompressible exsanguination. After injury, animals were treated with damage-control fluid resuscitation alone (n = 14) or foam treatment in addition to fluids. Two doses of foam treatment were studied: 100 mL (n = 12) and 120 mL (n = 13); all animals were monitored for 3 hours or until death.

Results: Foam treatment at both doses resulted in a significant survival benefit and reduction in hemorrhage rate relative to the control group. Median survival time was 135 minutes and 175 minutes for the 120-mL and 100-mL doses, compared with 32 minutes in the control group (p < 0.001 for both groups). Foam resulted in an immediate, persistent improvement in mean arterial pressure and a transient increase in intra-abdominal pressure. The median hemorrhage rate was 0.27 g/kg per minute in the 120-mL group and 0.23 g/kg per minute in the 100-mL group, compared with 1.4 g/kg per minute in the control group (p = 0.003 and 0.006, respectively, as compared with the control).

Conclusion: Self-expanding foam treatment significantly improves survival in an otherwise lethal, noncompressible, massive, arterial injury. This treatment may provide a prehospital intervention for control of noncompressible abdominal hemorrhage.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Abdominal Injuries / mortality*
  • Abdominal Injuries / therapy*
  • Animals
  • Arterial Pressure
  • Cardiac Output
  • Disease Models, Animal
  • Equipment Design
  • Exsanguination / mortality*
  • Exsanguination / therapy
  • Hemostatics / administration & dosage
  • Hemostatics / therapeutic use*
  • Iliac Artery / injuries*
  • Kaplan-Meier Estimate
  • Polyurethanes / administration & dosage*
  • Polyurethanes / therapeutic use
  • Swine

Substances

  • Hemostatics
  • Polyurethanes