Abstract
Management of Non-Compressible Torso Hemorrhage (NCTH) consists primarily of aortic occlusion which has significant adverse outcomes, including ischemia-reperfusion injury, in prolonged field care paradigms. One promising avenue for treatment is through use of RevMedx XSTAT 30™ (an FDA approved sponge-based dressing utilized for extremity wounds). We hypothesized that XSTAT 30™ would effectively mitigate NCTH during a prolonged pre-hospital period with correctable metabolic and physiologic derangements. Twenty-four male swine (53±2kg) were anesthetized, underwent line placement, and splenectomy. Animals then underwent laparoscopic transection of 70% of the left lobe of the liver with hemorrhage for a period of 10min. They were randomized into three groups: No intevention (CON), XSTAT 30™-Free Pellets (FP), and XSTAT 30™-Bagged Pellets (BP). Animals were observed for a pre-hospital period of 180min. At 180min, animals underwent damage control surgery (DCS), balanced blood product resuscitation and removal of pellets followed by an ICU period of 5 hours. Postoperative fluoroscopy was performed to identify remaining pellets or bags. Baseline physiologic and injury characteristics were similar. Survival rates were significantly higher in FP and BP (p<0.01) vs CON. DCS was significantly longer in FP in comparison to BP (p = 0.001). Two animals in the FP group had pellets discovered on fluoroscopy following DCS. There was no significant difference in blood product or pressor requirements between groups. End-ICU lactates trended to baseline in both FP and BP groups. While these results are promising, further study will be required to better understand the role for XSTAT in the management of NCTH.
Highlights
Traumatic non-compressible torso hemorrhage (NCTH) is the most common cause of potentially survivable deaths in both civilian and military trauma [1, 2]
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Animals underwent laparoscopic transection of 70% of the left lobe of the liver with hemorrhage for a period of 10min. They were randomized into three groups: No intevention (CON), XSTAT 30TM-Free Pellets (FP), and XSTAT 30TM-Bagged Pellets (BP)
Summary
Traumatic non-compressible torso hemorrhage (NCTH) is the most common cause of potentially survivable deaths in both civilian and military trauma [1, 2]. Increasing transport times limit the usefulness of extended Zone 1 aortic occlusion due to the high risk of ischemia reperfusion injury [5, 6] Hemostatic gauzes, such as QuikClot Combat Gauze, have been used to manage junctional and extremity hemorrhage, are not compatible with injury patterns that include abdominal hemorrhage [7]. The individual compressed sponges (pellets) that make up the XSTAT 30TM have radio-opaque markers for identification and have most recently been refined for use in severe uterine hemorrhage where sponges are deployed within a radio-opaque bag [9] Through these developments, XSTAT 30TM may have a broader application for pre-hospital intra-abdominal hemorrhage control. We hypothesized that XSTAT 30TM would effectively mitigate NCTH during a prolonged pre-hospital period with correctable metabolic and physiologic derangements
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