Application of a zeolite hemostatic agent achieves 100% survival in a lethal model of complex groin injury in swine

Hasan B. Alam*, Zheng Chen, Amin Jaskille, Racel Ireneo Luis C. Querol, Elena Koustova, Ryan Inocencio, Richard Conran, Adam Seufert, Nanna Ariaban, Kevin Toruno, Peter Rhee

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

159 Scopus citations

Abstract

Background: Techniques for better hemorrhage control after injury could change outcome. We have previously shown that a zeolite mineral hemostatic agent (ZH) can control aggressive bleeding through adsorption of water, which is an exothermic process. Increasing the residual moisture content (RM) of ZH can theoretically decrease heat generation, but its effect on the hemostatic properties is unknown. We tested ZH with increasing RM against controls and other hemostatic agents in a swine model of battlefield injury. Methods: A complex groin injury was created in 72 swine (37 ± 0.8 kg). This included semitransection of the proximal thigh and complete division of the femoral artery and vein. After 3 minutes, the animals were randomized to 1 of 10 groups: group 1, no dressing (ND); group 2, standard dressing (SD); group 3, SD + 3.5 oz ZH with 1% RM (1 % ZH); group 4, SD + 3.5 oz ZH with 4% RM (4% ZH); group 5, SD + 2 oz ZH with 1% RM (1% ZH 2oz); group 6, SD + 3.5 oz ZH with 8% RM (8% ZH); group 7, SD + chitosan-based hemostat, HemCon (HC); group 8, SD + 3.5 oz nonzeolite mineral hemostat, Quick Relief (NZH); group 9, SD + bovine clotting factors-based hemostat, Fast Act (FA); and group 10, SD + 30 g of starch-based hemostat, TraumaDex (TDex). Resuscitation (500 mL of Hespan over 30 minutes) was started 15 minutes after injury and hemodynamic monitoring was performed for 180 minutes. Primary endpoints were survival for 180 minutes and blood loss. In addition, maximum wound temperatures were recorded, and histologic damage to artery, vein, nerve, and muscle was documented. Results: Use of 1% ZH decreased blood loss and reduced mortality to 0% (p < 0.05). Increasing the RM adversely affected efficacy without any significant decrease in wound temperatures. Minimal histologic tissue damage was seen with ZH independent of the percentage of RM. Conclusion: The use of zeolite hemostatic agent (1 % residual moisture, 3.5 oz) can control hemorrhage and dramatically reduce mortality from a lethal groin wound.

Original languageEnglish (US)
Pages (from-to)974-983
Number of pages10
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume56
Issue number5
DOIs
StatePublished - May 2004
Externally publishedYes

Keywords

  • Battlefield injury
  • Chitosan
  • Extremity
  • Femoral vessels
  • Groin
  • Hemostatic dressing
  • Swine
  • Uncontrolled hemorrhage
  • Zeolite

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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