Kaolin-based hemostatic dressing improves hemorrhage control from a penetrating inferior vena cava injury in coagulopathic swine

Kiavash R. Koko, Brian M. McCauley, John P. Gaughan, Ryan S. Nolan, Marc W. Fromer, Ashleigh L.R. Hagaman, Rachel Choron, Spencer A. Brown, Joshua P. Hazelton

Research output: Contribution to journalArticle

Abstract

BACKGROUND Retrohepatic inferior vena cava (RIVC) injuries are often lethal due to challenges in obtaining hemorrhage control. We hypothesized that packing with a new kaolin-based hemostatic dressing (Control+; Z-Medica, Wallingford, CT) would improve hemorrhage control from a penetrating RIVC injury compared with packing with standard laparotomy sponges alone. METHODS Twelve male Yorkshire pigs received a 25% exchange transfusion of blood for refrigerated normal saline to induce a hypothermic coagulopathy. A laparotomy was performed and a standardized 1.5 cm injury to the RIVC was created which was followed by temporary abdominal closure and a period of uncontrolled hemorrhage. When the mean arterial pressure reached 70% of baseline, demonstrating hemorrhagic shock, the abdomen was re-entered, and the injury was treated with perihepatic packing using standard laparotomy sponges (L; n = 6) or a new kaolin-based hemostatic dressing (K; n = 6). Animals were then resuscitated for 6 hours with crystalloid solution. The two groups were compared using the Wilcoxon rank sum test and Fisher exact test. A p value of 0.05 or less was considered statistically significant. RESULTS There was no difference in the animal's temperature, heart rate, mean arterial pressure, cardiac output, and blood loss at baseline or before packing was performed (all p > 0.05). In the laparotomy sponge group, five of six pigs survived the entire study period, whereas all six pigs treated with kaolin-based D2 hemostatic dressings survived. Importantly, there was significantly less blood loss after packing with the new hemostatic kaolin-based dressing compared with packing with laparotomy sponge (651 ± 180 mL vs. 1073 ± 342 mL; p ≤ 0.05). CONCLUSION These results demonstrate that the use of this new hemostatic kaolin-based dressing improved hemorrhage control and significantly decreased blood loss in this penetrating RIVC model. LEVEL OF EVIDENCE This is basic science research based on a large animal model, level V.

Original languageEnglish (US)
Pages (from-to)71-76
Number of pages6
JournalJournal of Trauma and Acute Care Surgery
Volume83
Issue number1
DOIs
StatePublished - Jul 1 2017
Externally publishedYes

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Kaolin
Inferior Vena Cava
Hemostatics
Bandages
Laparotomy
Porifera
Swine
Hemorrhage
Wounds and Injuries
Nonparametric Statistics
Arterial Pressure
Hemorrhagic Shock
Blood Transfusion
Cardiac Output
Abdomen
Animal Models
Heart Rate
Temperature
Research

Keywords

  • Damage control laparotomy
  • hemostasis
  • hemostatic agent
  • kaolin
  • major vascular abdominal trauma
  • penetrating abdominal trauma
  • perihepatic packing
  • retrohepatic vena cava injury

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Kaolin-based hemostatic dressing improves hemorrhage control from a penetrating inferior vena cava injury in coagulopathic swine. / Koko, Kiavash R.; McCauley, Brian M.; Gaughan, John P.; Nolan, Ryan S.; Fromer, Marc W.; Hagaman, Ashleigh L.R.; Choron, Rachel; Brown, Spencer A.; Hazelton, Joshua P.

In: Journal of Trauma and Acute Care Surgery, Vol. 83, No. 1, 01.07.2017, p. 71-76.

Research output: Contribution to journalArticle

Koko, Kiavash R. ; McCauley, Brian M. ; Gaughan, John P. ; Nolan, Ryan S. ; Fromer, Marc W. ; Hagaman, Ashleigh L.R. ; Choron, Rachel ; Brown, Spencer A. ; Hazelton, Joshua P. / Kaolin-based hemostatic dressing improves hemorrhage control from a penetrating inferior vena cava injury in coagulopathic swine. In: Journal of Trauma and Acute Care Surgery. 2017 ; Vol. 83, No. 1. pp. 71-76.
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AU - Koko, Kiavash R.

AU - McCauley, Brian M.

AU - Gaughan, John P.

AU - Nolan, Ryan S.

AU - Fromer, Marc W.

AU - Hagaman, Ashleigh L.R.

AU - Choron, Rachel

AU - Brown, Spencer A.

AU - Hazelton, Joshua P.

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N2 - BACKGROUND Retrohepatic inferior vena cava (RIVC) injuries are often lethal due to challenges in obtaining hemorrhage control. We hypothesized that packing with a new kaolin-based hemostatic dressing (Control+; Z-Medica, Wallingford, CT) would improve hemorrhage control from a penetrating RIVC injury compared with packing with standard laparotomy sponges alone. METHODS Twelve male Yorkshire pigs received a 25% exchange transfusion of blood for refrigerated normal saline to induce a hypothermic coagulopathy. A laparotomy was performed and a standardized 1.5 cm injury to the RIVC was created which was followed by temporary abdominal closure and a period of uncontrolled hemorrhage. When the mean arterial pressure reached 70% of baseline, demonstrating hemorrhagic shock, the abdomen was re-entered, and the injury was treated with perihepatic packing using standard laparotomy sponges (L; n = 6) or a new kaolin-based hemostatic dressing (K; n = 6). Animals were then resuscitated for 6 hours with crystalloid solution. The two groups were compared using the Wilcoxon rank sum test and Fisher exact test. A p value of 0.05 or less was considered statistically significant. RESULTS There was no difference in the animal's temperature, heart rate, mean arterial pressure, cardiac output, and blood loss at baseline or before packing was performed (all p > 0.05). In the laparotomy sponge group, five of six pigs survived the entire study period, whereas all six pigs treated with kaolin-based D2 hemostatic dressings survived. Importantly, there was significantly less blood loss after packing with the new hemostatic kaolin-based dressing compared with packing with laparotomy sponge (651 ± 180 mL vs. 1073 ± 342 mL; p ≤ 0.05). CONCLUSION These results demonstrate that the use of this new hemostatic kaolin-based dressing improved hemorrhage control and significantly decreased blood loss in this penetrating RIVC model. LEVEL OF EVIDENCE This is basic science research based on a large animal model, level V.

AB - BACKGROUND Retrohepatic inferior vena cava (RIVC) injuries are often lethal due to challenges in obtaining hemorrhage control. We hypothesized that packing with a new kaolin-based hemostatic dressing (Control+; Z-Medica, Wallingford, CT) would improve hemorrhage control from a penetrating RIVC injury compared with packing with standard laparotomy sponges alone. METHODS Twelve male Yorkshire pigs received a 25% exchange transfusion of blood for refrigerated normal saline to induce a hypothermic coagulopathy. A laparotomy was performed and a standardized 1.5 cm injury to the RIVC was created which was followed by temporary abdominal closure and a period of uncontrolled hemorrhage. When the mean arterial pressure reached 70% of baseline, demonstrating hemorrhagic shock, the abdomen was re-entered, and the injury was treated with perihepatic packing using standard laparotomy sponges (L; n = 6) or a new kaolin-based hemostatic dressing (K; n = 6). Animals were then resuscitated for 6 hours with crystalloid solution. The two groups were compared using the Wilcoxon rank sum test and Fisher exact test. A p value of 0.05 or less was considered statistically significant. RESULTS There was no difference in the animal's temperature, heart rate, mean arterial pressure, cardiac output, and blood loss at baseline or before packing was performed (all p > 0.05). In the laparotomy sponge group, five of six pigs survived the entire study period, whereas all six pigs treated with kaolin-based D2 hemostatic dressings survived. Importantly, there was significantly less blood loss after packing with the new hemostatic kaolin-based dressing compared with packing with laparotomy sponge (651 ± 180 mL vs. 1073 ± 342 mL; p ≤ 0.05). CONCLUSION These results demonstrate that the use of this new hemostatic kaolin-based dressing improved hemorrhage control and significantly decreased blood loss in this penetrating RIVC model. LEVEL OF EVIDENCE This is basic science research based on a large animal model, level V.

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KW - retrohepatic vena cava injury

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