Abstract 177: Testing of a Novel Pelvic Hemostasis Belt to Control Lethal Pelvic Arterial Hemorrhage

Abstract

Objectives: Hemorrhage is the leading cause of death for both battlefield and injuries civilian. Hemorrhage caused by pelvic vascular injuries is of particular concern since it is challenging to manage or control prior to surgical intervention. Recently, there has been renewed interest in developing pre-surgical endovascular interventions to control such hemorrhage. However, other short-term techniques may be needed as a conduit to such endovascular approaches. Attempts at external tamponade of these complex injuries as a bridge to definitive surgical care of such injuries is not new. We tested a prototype device called the Pelvic Hemostasis Belt (PHB) for its ability to reduce or stop blood flow in a lethal model of pelvic arterial injury. Methods: Twelve male swine, 43(5.6) kg were utilized in this study. Animals were anesthetized, instrumented then randomized into two groups, Military Anti Shock Trousers group (MAST) and Pelvic Hemostasis Belt group (PHB). Through laparotomy, a stainless-steel monofilament suture was placed through the right iliac artery, the abdomen was closed and the suture was exteriorized. Hemorrhage was produced by pulling the suture through the iliac artery. In both groups, the hemostasis devices (MAST or BHP) were applied over the pelvis and lower abdomen for 60 minutes followed by release and monitoring for 30 minutes or until the animal expired. An infusion of 500 mL of hetastarch was started immediately after initiation of hemorrhage. Results: All animals in the PHB group and only two from the MAST group survived for 60 minutes. Average survival time for the rest of the MAST group was 44(17.9) minutes. The log-rank (Mantel-Cox) survival analysis demonstrated a significant difference in survival time between PHB and MAST group (p = 0.018). Significant differences were noted between the two groups in mean arterial pressure, lactate and central venous hemoglobin oxygen saturation levels. Conclusion: The PHB was successful in improving survival for 60 minutes after a lethal vascular injury. The Pelvic Hemostasis Belt might be helpful to bridge endovascular methods of hemorrhage control.