• Anthony E Pusateri, Harold E Modrow, Richard A Harris, John B Holcomb, John R Hess, Robert H Mosebar, Thomas J Reid, James H Nelson, Cleon W Goodwin, Glenn M Fitzpatrick, Albert T McManus, David T Zolock, Jill L Sondeen, Rhonda L Cornum, and Raul S Martinez.
• US Army Institute of Surgical Research, Fort Sam Houston, TX 78234-6315, USA. anthony.pusateri@cen.amedd.army.mil
• J Trauma. 2003 Sep 1;55(3):518-26.

BackgroundAn 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.MethodsSwine 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.ResultsThe 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.ConclusionThe hemorrhage model allowed differentiation among topical hemostatic agents for severe hemorrhage. The American Red Cross hemostatic dressing was effective and warrants further development.

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