A. Chaturvedi2, M. B. Dowling4, J. P. Gustin3, T. M. Scalea2, S. R. Raghavan3, M. Narayan2 2University Of Maryland,R Adams Cowley Shock Trauma Center,Baltimore, MD, USA 3University Of Maryland,Department Of Chemical & Biomolecular Engineering,College Park, MD, USA 4University Of Maryland,Fischell Department Of Bioengineering,College Park, MD, USA
Introduction:
Currently, the standard of care for treating severe hemorrhage in a military setting is Combat GauzeTM(CG). Previous work has shown that hydrophobically modified (hm) chitosan has great hemostatic potential. This work aims to create a hm-chitosan coated gauze to directly compare to CG as well as ChitoGauze® (ChG) in a lethal in vivo hemorrhage model.
Methods:
Twelve Yorkshire swine were randomized to receive either hm-chitosan gauze (n = 4), ChG (n = 4), or CG (n = 4). A standard hemorrhage model was used in which animals underwent a splenectomy prior to a 6 mm punch arterial puncture of the femoral artery. Thirty seconds of free bleeding was allowed before dressings were applied and compressed for 3 minutes. Baseline mean arterial pressure was preserved via fluid resuscitation. Experiments were conducted for three hours after which any surviving animal was euthanized.
Results:
Hm-chitosan gauze was found to be at least equivalent to both CG and ChG in terms of overall survival(100% v 75%), number of dressing used(6 v 7), and duration of hemostasis (3 hrs v 2.25 hrs). Total post-treatment blood loss was significantly lower in the hm-chitosan gauze treatment group (4.7 mL/kg) when compared to CG(13.4 mL/kg) and ChG(12.1 mL/kg) groups (p =< 0.0001)
Conclusion:
Hm-chitosan gauze appears to have outperformed both CG and ChG in a lethal hemorrhage model. However given the small treatment group size, the only measured outcome that was significantly different was total post-treatment blood loss. Future comparison of hm-chitosan gauze to CG and ChG will be performed on a hypothermic and coagulapathic model that should allow for outcome significance to be differentiated under small treatment groups.
