Control Of Massive Hemorrhage Research Articles

A novel sodium polyacrylate-based stasis dressing to treat lethal hemorrhage in a penetrating trauma swine model.

Control of massive hemorrhage from penetrating wound sites is difficult in both combat and civilian settings. A new hemostatic dressing, sodium polyacrylate (PAAs)-based bag (PB), based on PAAs is designed for the first aid of massive penetrating hemorrhage. This study aimed to investigate the efficacy of PB in a penetrating trauma model in swine. A complex groin penetrating injury was produced in swine by completely excising the femoral vessels and surrounding muscles. After 15-second free bleeding, 18 healthy Guizhou female swine were administered PB (n = 6), CELOX-A (n = 6; Medtrade Products, Crewe, United Kingdom), or standard gauze (n = 6) for hemostatic intervention, followed by 3-minute compression if the bleeding persisted, with subsequent observation continuing for 1 hour. The primary outcomes included initial hemostasis, the incidence of applying manual pressure, and application time. Sodium polyacrylate could rapidly absorb the liquid to expand, crosslink with a large number of red blood cells, induce cellular morphological alteration, and promote blood coagulation. Sodium polyacrylate-based bag and CELOX-A initiated and sustained hemostasis for 60 minutes, whereas 0% of the standard gauze achieved initial hemostasis. Maximum number of manual compressions were applied in standard gauze (6 of 6 [100%]), followed by CELOX-A (5 of 6 [80%]), while no manual pressure was required in the case of PB (0 of 6 [0%]). Application time for PB (19.0 ± 4.6 seconds) was significantly less than CELOX-A (169.0 ± 73.5 seconds) and standard gauze (187.8 ± 1.7 seconds). We prepared a type of superabsorbent PAAs and made an original hemostatic dressing, PB. It can rapidly achieve durable hemostasis in the groin-penetrating trauma hemorrhage swine model without any external compression. The packet form makes PB easy to deploy and remove from wounds. Therefore, PB could be a promising hemostatic candidate for controlling penetrating hemorrhage.

Cationic superabsorbent hydrogel composed of mesoporous silica as a potential haemostatic material.

The control of massive bleeding and its related wound infection is the main challenge for both military and civilian trauma centres. In this study, a cationic superabsorbent hydrogel coordinated by mesoporous silica (CSH-MS) was synthesized by free-radical polymerization for both haemostasis and antibacterial use. The as-prepared CSH-MS has a rough surface, and its water absorption is approximately 5000%. The resultant CSH-MS1 could promote blood cell aggregation and facilitate plasma protein activation via haemadsorption, resulting in efficient blood clot formation. Furthermore, CSH-MS1 (with approximately 5.06% contents of MS) dramatically reduces bleeding time and reduces blood loss in a rat-tail amputation model. Moreover, the CSH-MSs exhibits good antibacterial activities, excellent cytocompatibility and negligible haemolysis. Therefore, CSH-MS can serve as a novel type of haemostatic material in clinical applications.

A Case Study on Placenta Percreta

Placenta percreta is a serious pregnancy condition that occurs when blood vessels and other parts of the placenta grow the deeply into the uterine wall. Placenta percreta is a rare but a life-threatening condition. Control of massive haemorrhage is the first priority; however, the patient's desire for future fertility has to be taken into consideration. Here we present a case where we had to do a quick subtotal hysterectomy because of torrential bleed due to placenta percreta with severe abdominal pain.

Successful Control of Massive Bleeding in a Child with Burkitt's Lymphoma via a Biosimilar Recombinant Activated Factor VII (AryoSeven™).

We describe a case of a 4-year-old girl with Burkitt's lymphoma, who suffered from a massive gastrointestinal hemorrhage 3 days after chemotherapy. In spite of applying the common practice in correction of coagulopathy, thrombocytopenia persisted and bleeding became life-threatening. In the present case report, we report a successful control of bleeding with a single-dose administration of a biosimilar recombinant activated human factor VII (AryoSeven).

(ii) Resuscitation of the adult trauma victim

Abstract The introduction of Major Trauma Networks has had a significant positive impact on the delivery of care to the seriously injured patient. Trauma is still the most common cause of death in patients under the age of 45. The hub and spoke model of the Trauma Unit – MTC has resulted in standardization of trauma care across England and the resultant improvement in patient mortality is evident in the most recent TARN data summary. Dedicated, consultant-led ‘Trauma Teams’ now direct the care of the critically injured from their first presentation at the emergency department. Priorities for the resuscitation of the severely injured patient follow ATLS principles, with control of massive haemorrhage given equal priority to the airway. The pre-hospital administration of tranexamic acid and intravenous antibiotics in the setting of hypovolaemic shock and open fractures represent new advances in standards of emergent care.

The clinical observation of two methods of hemostasis in the management of hemorrhage in central placenta previa during cesarean section

Objective To discuss and validate which method is more effectiveness for central placenta previa through analysing the clinical outcomes of the management of hemorrhage between uterine packing and stitching hemostasis during cesarean section. Methods 48 pregnant women with central placenta previa was conducted in this retrospective study, which were all cesarean section delivery. These patients were divided into two groups.24 patients with uterine packing with gauze in the control of massive hemorrhage during cesarean section were indetified, otherwise, the other 24 patients were conducted with sewing and ligation uterine. And then, the effectiveness and outcomes were compared. Results These all patients were alive and keep the uterus. The average estimated blood loss of the stiching group was(554±327)mL, obviously less than the uterine packing group, which was(828±584)mL, and the difference was statisatically significant(t=6.689,P 0.05). Conclusion The uterine stiching is an effective, rapid and simple technique in the control of hemorrhage of central placenta previa. Key words: Stiching hemostasis; Central placenta previa; The hemostatic effect

Placenta percreta – an obstetrician's nightmare

Placenta percreta is a rare but a life threatening condition. Control of massive haemorrhage is the first priority; however, the patient's desire for future fertility has to be taken into consideration. Nevertheless, in cases of massive haemorrhage, hysterectomy should be carried out without delay to prevent major complications or even maternal death. Here we present a case where we had to do a quick subtotal hysterectomy because of torrential bleed due to placenta percreta. <strong>Key words: </strong>Placenta percreta; hysterectomy; haemorrhage.<strong><em> </em></strong> DOI: <a href="http://dx.doi.org/10.4038/sljog.v32i2.3978">http://dx.doi.org/10.4038/sljog.v32i2.3978</a> <em>SLJOG </em>2010; 32(2): 39-40

Role of Uterine Artery Embolization in the Management of Cervical Cancer: Review Article

This article explores the role of uterine artery embolization in the management of bleeding secondary to cervical carcinoma. Uterine artery embolization is a safe and effective treatment for control of massive bleeding in cervical cancer. This conservative treatment not only improve the patients quality of life by reducing the risk of profound anaemia but also help them to be ready for the next phase of treatment which could be radiotherapy or surgery.

Uterine packing during cesarean section in the management of intractable hemorrhage in central placenta previa

To determine the safety and effectiveness of uterine packing in the management of intractable hemorrhage during cesarean section for central placenta previa. This retrospective study was conducted on 70 pregnant women with central placenta previa from May 2005 to March 2010. Patients with uterine packing in the control of massive hemorrhage during cesarean section were identified. The indications, uterine packing procedures, estimated blood loss, postoperative complications, and packing material used were reviewed. A total of 70 patients were identified among 1,121 women with placenta previa during the study period. Sixty-five cases were successful in the control of intraoperative bleeding using uterine packing. Two patients with severe placenta accreta had hemorrhage during cesarean section, and packing with gauze in the uterine cavity was not able to control the bleeding, thereby resulting in cesarean hysterectomy. One case demonstrated failure in packing because of disseminated intravascular coagulation occurring before hospital admission. The remaining two patients had massive vaginal bleeding after uterine packing in cesarean section and underwent laparotomy or hysterectomy 4 h postoperative. Uterine packing is a safe and effective technique in the control of intractable hemorrhage in cesarean section. It is a reasonable alternative to further surgical intervention in patients with intractable obstetric hemorrhage, especially in developing countries.

Prehospital Emergency Thoracotomy: When to Do It?

Traumatic injuries still constitute one of the leading causes of death in all age groups. Emergency thoracotomy is a procedure carried out in patients presenting in extremis. The primary goals are the control of massive hemorrhage, the release of cardiac tamponade, the internal or open cardiac massage, the prevention or control of air embolism, the control of bronchopleural fistulae and the cross-clamping of descending aorta. Although the usefulness of prehospital emergency thoracotomy remains controversial and specific guidelines are lacking, when faced with no alternative, it can be a lifesaving procedure. A comprehensive search for relevant studies was performed from 1975 to the present. An algorithm is proposed to assist physicians in deciding when to perform on scene thoracotomy.

Control of massive bleeding in dengue hemorrhagic fever with severe thrombocytopenia by use of intravenous anti‐D globulin

Dengue hemorrhagic fever (DHF) is a potentially lethal complication of mosquito borne viral disease, Dengue Fever. Thrombocytopenia is a constant finding in DHF/Dengue Shock Syndrome (DSS). We report two cases that fulfilled the WHO criteria of DSS: high fever, positive tourniquet test, severe thrombocytopenia (<10,000/mm(3)), hemo-concentration (Hematocrit increase >20%), hypotension and bleeding refractory to routine therapeutic measures, who showed dramatic improvement after receiving Intravenous Anti-D globulin (IV anti-D).

Control of Massive Bleeding in Dengue Hemorrhagic Fever with Severe Thrombocytopenia by Use of KhamRho IV Anti D®.

Dengue hemorrhagic fever (DHF) is a potentially lethal complication of mosquito borne viral disease, Dengue Fever. Thrombocytopenia is a constant finding in DHF/Dengue Shock Syndrome (DSS). The cause of thrombocytopenia is not clearly understood and may be due to decreased platelet production, increased peripheral destruction, or both. IV Anti-D is currently licensed to treat immune thrombocytopenia purpura (ITP) in pediatric or adult patients. Unlike other disease states, which may produce ITP, the thrombocytopenia associated with DHF has an acute onset and a high mortality rate if untreated. Use of Intravenous anti D (IV anti-D) for such bleeding has not been documented in the literature which prompted these descriptionsMethod: We report 2 cases that fulfilled the WHO criteria of DHF: high fever, bleeding, positive tourniquet test, severe thrombocytopenia (<10,000 /mm3) and hemoconcentration (Hematocrit increase> 20%).Case 1: 14-year-old boy was admitted with DHF and hypotension. He was stabilized after a normal saline (NS) bolus and continued on intravenous fluids @3ml/kg/hr. On day 3 of admission he again became hypotensive that responded to NS bolus and increased fluid rate of 5 ml/kg/hr. On day 4 child developed respiratory distress had to be ventilated in view of associated hypotension and deteriorating general condition. Echocardiogram showed global hypokinesia with Left Ventricular Ejection Fraction of 43% so started on inotropes. Few hours later he developed massive pulmonary hemorrhage. The pulmonary hemorrhage continued despite giving 42 units of platelets, 10 units of FFP and 3 units of aphaeresis. Platelet count remained less than 10,000 / mm3 despite repeated platelet transfusions. Recombinant Activated factor VII was given at a dose of 90 ug/kg which corrected coagulation profile to normal but hemorrhage still persisted. KhamRho IV Anti D® 50ug/kg was administered after which child showed dramatic response and bleeding stopped after 4 hr and platelets increased to 30,000 after 6 hr. Over next 48 hrs platelet count rose further. He was gradually weaned off the inotropes and ventilatory support.Case 2: 5-year-old girl admitted with DHF. On admission she was hypotensive and was having massive gastrointestinal bleed. She was given crystalloids/colloids and later started on dopamine infusion. She was intubated in view of deteriorating general condition and hemodynamic instability. She was managed as per the guidelines of dengue shock syndrome after which her hemodynamic status improved but bleeding continued for which she received 16 units of platelet concentrate, 1 unit aphaeresis along with 4 units of FFP and 1 unit cryoprecipitate in view of deranged coagulation profile. Platelet count remained less than 10,000 / mm3 despite platelet transfusion. Despite all these measures her bleeding continued thus a trial of activated factor VII 90 ug/kg two doses 1 hour apart was given but still bleeding persisted. KhamRho IV Anti D®50ug /kg single dose was administered after which child blood pressure stabilized and bleeding stopped after 3 hr. Platelet counts improved and she was gradually weaned off the inotropes and ventilatory support.Conclusion: The response observed in these patients demonstrates that the massive bleeding due to thrombocytopenia associated with DHF responds rapidly to treatment with IV Anti-D. There were no serious adverse events observed in both the patients.

The Tumor: A Simulator for Open Surgery

Few simulation tools for practicing open surgical skills have been developed. We have built and tested a device that allows a learner to practice careful dissection, hemostasis, tying off blood vessels with suture in deep locations, and control of massive hemorrhage. The device is inexpensive, applicable to a wide range of surgical specialties, and can produce robust measurement of skills. The Tumor is a device that represents a generic vascularized growth in a non-specific tissue medium. It is constructed of readily available materials and can be discarded after each use. The tumor model is constructed from a pluot (a cross between a plum and an apricot, approximately 5 cm in diameter) that has been pitted, frozen and thawed. Gelatin tinted with food coloring in a plastic food bowl represents the surrounding tissue. The pluot is imbedded in the gelatin so that 25% of the fruit is exposed. Four lengths of Silastic rubber (1.47 mm ID, 1.96 mm ID) tubing are threaded through the pluot to represent blood vessels. A fifth length of tubing of greater diameter is located under the core of the pluot to enable simulation of massive hemorrhage. Solenoid valves are used to control the pulsatile flow of red fluid from a pressure bag through the rubber blood vessels. The model must be refrigerated prior to use, but remains stable for approximately two hours at room temperature. Surgical exposure can be adjusted by cutting a hole in the cover of the food bowl to a desired size. At any time, the controller can produce bleeding from one of the minor or from the major blood vessel via the solenoid valves. A learner is instructed to resect the tumor carefully using a limited set of basic surgical instruments so that the margin is maintained with as little damage to the tumor body and surrounding tissue as possible. The tumor is described as vascular, friable, and that bleeding may occur as it is manipulated. Blood vessels must be cut and tied with 3–0 silk sutures to keep blood loss to a minimum. We have used the tumor model to engage surgeons during simulations centered on team training as a means to more closely replicate surgical tasks in the actual operating room. The nature of the model requires coordination with assistants and scrub nurses and also makes their jobs during simulation more realistic. The ability to create massive hemorrhage also allows for the creation of simulation scenarios based on the surgical field itself, a departure from scenarios that are often anesthesia based. We hope to expand the use of the model in the future as a training device and possibly as a measure of surgical skill and judgment after validation studies to correlate surgical experience with technical performance on the model. Conflict of Interest: Authors indicated they have nothing to disclose.

Control of massive bleeding from facial gunshot wound with a compact elastic adhesive compression dressing

The issue of immediate control of acute external traumatic hemorrhage is poorly dealt with in the medical literature. A compact unit incorporating the desired components capable of applying significant compression over diverse body areas has been suggested in the past but not formally demonstrated effective in practice. In this report we describe the treatment of a young man presenting with a very large, complex, profusely bleeding facial gunshot wound. The calvarium remained intact. The upper airway was diverted and secured by performing a cricothyroidotomy. A transparent elastic adhesive dressing was then applied by covering the anterior aspect of the face by a contact pad followed by sequential wrapping of the roll covering all structures between the forehead and the neck. This procedure successfully controlled the hemorrhage and maintained the victim’s condition hemodynamically stable until definitive surgical intervention at the level 1 medical center. We attribute the survival of this victim to the innovative dressing technique and excellent cooperation between the trauma team and hospital staff. This case demonstrates the contribution of elastic adhesive compression dressing towards saving the lives of those inflicted by severely challenging bleeding wounds. We sugggest this technique be considered by Emergency personnel working in the prehospital arena in selected cases.

Postpartum Hemorrhage: A Review

Postpartum hemorrhage is a significant cause of maternal mortality. The etiologies and various management options available to the clinician are discussed below. Special attention is paid to the surgical and angiographic techniques used in the control of massive hemorrhage.

Emergent Embolization for Control of Massive Hemorrhage from a Splanchnic Artery with a New Coaxial Catheter System

Emergent superselective embolization with a 3.0 F (1 mm) coaxial catheter and a steerable guidewire was performed in 27 patients with massive hemorrhage from a small-caliber splanchnic artery. Eight patients had intraperitoneal hemorrhage, 3 had hemobilia, 9 had gastric hemorrhage, and 7 had intestinal hemorrhage. Out of 27 patients, 7 had hemorrhage from a splanchnic artery pseudoaneurysm. Complete cessation of bleeding was obtained in all patients initially, but in 3 patients gastric hemorrhage recurred later. Otherwise, there was no rebleeding nor any major complication such as marked infarction of tissue or misplacement of embolic materials. This coaxial catheter system was highly reliable for achieving superselective catheterization in small-caliber arteries, minimizing the volume of infarcted tissue and allowing maximal preservation of splanchnic organic function. We conclude that this system represents a major advance in interventional radiology.

Emergent Embolization for Control of Massive Hemorrhage from a Splanchnic Artery with a New Coaxial Catheter System

Emergent superselective embolization with a 3.0 F (1 mm) coaxial catheter and a steerable guidewire was performed in 27 patients with massive hemorrhage from a small-caliber splanchnic artery. Eight patients had intraperitoneal hemorrhage, 3 had hemobilia, 9 had gastric hemorrhage, and 7 had intestinal hemorrhage. Out of 27 patients, 7 had hemorrhage from a splanchnic artery pseudoaneurysm. Complete cessation of bleeding was obtained in all patients initially, but in 3 patients gastric hemorrhage recurred later. Otherwise, there was no rebleeding nor any major complication such as marked infarction of tissue or misplacement of embolic materials. This coaxial catheter system was highly reliable for achieving superselective catheterization in small-caliber arteries, minimizing the volume of infarcted tissue and allowing maximal preservation of splanchnic organic function. We conclude that this system represents a major advance in interventional radiology.

Emergent Embolization for Control of Massive Hemorrhage from a Splanchnic Artery with a New Coaxial Catheter System

Emergent Embolization for Control of Massive Hemorrhage from a Splanchnic Artery with a New Coaxial Catheter System

Control of massive hemorrhage from rectal varices with sclerotherapy

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Control of massive bleeding from hemorrhoidal veins

Control of massive bleeding from hemorrhoidal veins