1
|
Nguyen M, Tran L, Foreman A, Lockwood C. The effectiveness of fibrin sealants in head and neck surgery: a systematic review and meta-analysis. Syst Rev 2024; 13:246. [PMID: 39342380 DOI: 10.1186/s13643-024-02634-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 08/08/2024] [Indexed: 10/01/2024] Open
Abstract
BACKGROUND Fibrin sealants are increasingly used in head and neck surgery to aid hemostasis, but individual studies lack conclusive evidence. This systematic review investigates their effectiveness compared to placebo or usual care in head and neck surgery. METHODS Studies comparing fibrin sealant to placebo or usual care in patients 18 years or older who have undergone soft tissue surgery of the head and neck with drain placement were included. Primary outcomes include wound complications and time to surgical drain removal postoperatively. Secondary outcomes include length of hospital stay, drain volume output, surgical management of hematoma, blood transfusion rates, and adverse reactions. Electronic databases were searched on October 2023 for randomized controlled and quasi-experimental studies. Studies underwent independent screening, review, and appraisal by two reviewers using JBI appraisal tools. Certainty was assessed with GRADE, and meta-analysis was conducted using JBI SUMARI, presenting effect sizes as relative risk ratios or mean differences with 95% confidence intervals. RESULTS Fourteen studies were included examining 904 patients. The fibrin sealant group exhibited reduced postoperative wound complications (hematoma, seroma, wound dehiscence, wound infection) (RR = 0.64, 95% CI = 0.45-0.92), shorter drain removal times (MD = - 0.49 days, 95% CI = - 0.68 to - 0.29), decreased drain output (MD = - 16.52 mL, 95% CI = - 18.56 to - 14.52), and shorter hospital stay (MD = - 0.84 days, 95% CI = - 1.11 to - 0.57) compared to controls. There was no statistically significant difference on the rate of intervention for postoperative hematoma and the rate of adverse reactions. DISCUSSION Evidence demonstrates with low certainty that fibrin sealant use is associated with a modest reduction in the rate of wound complications, drain duration, and length of stay, and a small reduction in drain volume output. Methodological weaknesses and clinical heterogeneity limit these findings. Further research should focus on enhancing methodological quality and exploring the cost-effectiveness of fibrin sealant use in surgery. SYSTEMATIC REVIEW REGISTRATION CRD42023412820. FUNDING Nil.
Collapse
Affiliation(s)
- Marie Nguyen
- JBI, School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia.
- Department of Otorhinolaryngology, Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
| | - Liem Tran
- JBI, School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Andrew Foreman
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Department of Otorhinolaryngology, Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Craig Lockwood
- JBI, School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| |
Collapse
|
2
|
Nguyen M, Foreman A, Lockwood C. Effectiveness of fibrin sealants in head and neck surgery: a systematic review protocol. JBI Evid Synth 2024; 22:1151-1160. [PMID: 38015095 DOI: 10.11124/jbies-23-00142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
OBJECTIVE This review will investigate the effectiveness of fibrin sealants in adult patients who underwent head and neck surgery. INTRODUCTION Controlling bleeding is important in head and neck surgery. Complications involving nearby vital structures increase the risk of morbidity and mortality. Surgical tissue adhesives are used in addition to other traditional hemostatic methods to reduce surgical site bleeding. Fibrin sealants have shown some success compared with other tissue adhesives, but individual studies have been inconclusive. INCLUSION CRITERIA We will include studies comparing fibrin sealants with placebo or usual care in patients 18 years or older who have undergone soft tissue surgery of the head and neck with drain placement. Primary outcomes include wound complications and time to surgical drain removal. Secondary outcomes include length of hospital stay, drain volume output, surgical management of postoperative hematoma, rate of blood transfusions, and adverse reactions. METHODS We will search electronic databases (PubMed, Embase, Cochrane Central Register of Controlled Trials CINAHL, Scopus, Web of Science) for studies published from 1975 onwards. Sources to be search for unpublished literature will include ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, MedNar, and ProQuest Dissertations and Theses. Titles, abstracts, and full-text papers will be assessed against the inclusion criteria by 2 independent reviewers. Study screening and selection will be performed, and critical appraisal conducted using the standardized JBI appraisal tools. Data will be extracted by 2 independent reviewers. Meta-analysis will be conducted for all outcomes where appropriate, with weighted mean differences for continuous data. Risk ratios will be used for dichotomous data. Certainty will be reported using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. REVIEW REGISTRATION PROSPERO CRD42023412820.
Collapse
Affiliation(s)
- Marie Nguyen
- JBI, School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
- Department of Otorhinolaryngology, Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Andrew Foreman
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
- Department of Otorhinolaryngology, Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Craig Lockwood
- JBI, School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| |
Collapse
|
3
|
Montano-Pedroso JC, Rodrigues RDR, Perini FV, Oliveira LC, Donizetti E, Rizzo SRCP, Rabello G, Junior DML. Consensus of the Brazilian association of hematology, hemotherapy and cellular therapy on patient blood management: Intraoperative hemostasis and volume replacement. Hematol Transfus Cell Ther 2024; 46 Suppl 1:S32-S39. [PMID: 38582746 PMCID: PMC11069062 DOI: 10.1016/j.htct.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 02/18/2024] [Indexed: 04/08/2024] Open
Abstract
Hemostasis plays a critical role in surgical procedures and is essential for a successful outcome. Advances in hemostatic agents offer new approaches to controlling bleeding thereby making surgeries safer. The appropriate choice of these agents is crucial. Volume replacement, another integral part of Patient Blood Management (PBM), maintains adequate tissue perfusion, preventing cellular damage. Individualization in fluid administration is vital with the choice between crystalloids and colloids depending on each case. Colloids, unlike crystalloids, increase oncotic pressure, contributing to fluid retention in the intravascular space. Understanding these aspects is essential to ensure safe and effective surgery, minimizing complications related to blood loss and maintaining the patient's hemodynamic status.
Collapse
Affiliation(s)
- Juan Carlos Montano-Pedroso
- Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil; Instituto de Assistência Médica do Servidor Público Estadual (Iamspe), São Paulo, SP, Brazil
| | - Roseny Dos Reis Rodrigues
- Hospital Israelita Albert Einstein são Paulo, São Paulo, SP, Brazil; Faculdade de Medicina da Universidade de São Paulo (FM USP), São Paulo, SP, Brazil
| | - Fernanda Vieira Perini
- Grupo GSH - Gestor de Serviços de Hemoterapia, São Paulo, SP, Brazil; Associação Beneficente Síria HCOR, São Paulo, SP, Brazil
| | - Luciana Correa Oliveira
- Hemocentro de Ribeirão Preto, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
| | | | | | - Guilherme Rabello
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (Incor - HCFMUSP), São Paulo, SP, Brazil.
| | | |
Collapse
|
4
|
Lake SP, Bradbury K, Gagne DH, Deeken CR, Badhwar A, Bohnen A. Efficacy of Flowable Collagen Hemostat Evaluated in Preclinical Models of Liver Injury and Spinal Cord Exposure. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2023; 16:123-132. [PMID: 37304735 PMCID: PMC10257272 DOI: 10.2147/mder.s411735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/29/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction Excessive bleeding in trauma and surgical settings leads to increased operative time, reoperation rates, and overall healthcare costs. A wide range of hemostatic agents have been developed to control bleeding that can vary considerably in type of hemostatic action, ease of application, cost, risk of infection, and dependence on patient coagulation. Microfibrillar collagen-based hemostatic materials (MCH) have yielded beneficial results in a variety of applications. Methods A new flowable collagen product, containing a modified MCH flour, but in a more convenient flowable delivery system, was evaluated for hemostatic efficacy in preclinical models of solid organ injury and spinal cord exposure. The primary objective of this study was to compare the hemostatic potential and local tissue responses to this novel, flowable collagen-based hemostatic agent to the original flour formulation to confirm that the new method of delivery did not interfere with the hemostatic properties of the MCH flour. Results When observed visually, the flowable MCH flour mixed with saline (FL) provided more precise application and uniform coverage to injured tissues compared to the dry MCH flour alone (F0). All of the treatments (FL, F0, and gauze) exhibited comparable Lewis bleed grade at all three time points evaluated in the capsular resection liver injury model (bleed grade: 1.0-1.3; p> 0.05 in all cases). FL and F0 exhibited comparable 100% acute hemostatic efficacy and similar long-term histomorphological properties (up to 120 days) in a capsular resection liver injury in pigs, while gauze resulted in significantly lower rates of acute hemostatic efficacy (8-42%, p<0.05 in all cases). In an ovine model of dorsal laminectomy and durotomy, FL and F0 again exhibited comparable results without any neurological effects. Conclusion Flowable microfibrillar collagen was shown to yield favorable short- and long-term outcomes in two representative applications where hemostatic efficacy is critical to surgical success.
Collapse
Affiliation(s)
- Spencer P Lake
- Department of Mechanical Engineering & Materials Science, Washington University in St. Louis, St. Louis, MO, USA
| | | | | | | | | | | |
Collapse
|
5
|
Halvorsen S, Mehilli J, Cassese S, Hall TS, Abdelhamid M, Barbato E, De Hert S, de Laval I, Geisler T, Hinterbuchner L, Ibanez B, Lenarczyk R, Mansmann UR, McGreavy P, Mueller C, Muneretto C, Niessner A, Potpara TS, Ristić A, Sade LE, Schirmer H, Schüpke S, Sillesen H, Skulstad H, Torracca L, Tutarel O, Van Der Meer P, Wojakowski W, Zacharowski K. 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery. Eur Heart J 2022; 43:3826-3924. [PMID: 36017553 DOI: 10.1093/eurheartj/ehac270] [Citation(s) in RCA: 287] [Impact Index Per Article: 143.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
|
6
|
Choi GS, Kim SH, Seo HI, Ryu JH, Yun SP, Koh MY, Lee MS, Lee H, Kim JH. A multicenter, prospective, randomized clinical trial of marine mussel-inspired adhesive hemostatic materials, InnoSEAL Plus. Ann Surg Treat Res 2021; 101:299-305. [PMID: 34796146 PMCID: PMC8564078 DOI: 10.4174/astr.2021.101.5.299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/09/2021] [Accepted: 09/28/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose InnoSEAL Plus is an adhesive, coagulant-free hemostatic material that mimics the adhesion mechanism of marine mussels. This study reports on the safety and efficacy of InnoSEAL Plus for patients with hemorrhage after hepatectomy despite first-line hemostasis treatments. Methods This is a multicenter, prospective, single-blinded, randomized clinical trial involving 96 hepatectomy patients. TachoSil was used as a comparator group. Three-minute and 10-minute hemostatic success rates were monitored. Rebleeding rates were also observed. Safety was assessed by recording all novel undesirable symptoms. Results InnoSEAL Plus showed a 3-minute hemostasis rate of 100%, while TachoSil had a rate of 98.0% (48 of 49 patients), demonstrating that the 2 had similar hemostatic efficacies. The difference in efficacy between the test and comparator group was 2.04%, and the lower limit of the one-sided 97.5% confidence interval was −1.92%; as this is greater than the noninferiority limit of −23.9%, the 2 treatments were equivalent. Meanwhile, the 10-minute hemostatic success rate was the same in both groups (100%). No rebleeding occurred in either group. In the safety evaluation, 89 patients experienced adverse events (45 in the test group and 44 in the comparator group). The difference between the 2 groups was not significant. No death occurred after application of the test or comparator group product. Conclusion Given that InnoSEAL Plus is a coagulation factor-free product, the hemostasis results are encouraging, especially considering that TachoSil contains a coagulation factor. InnoSEAL Plus was found to be a safe and effective hemostatic material for control of bleeding in hepatectomy patients.
Collapse
Affiliation(s)
- Gyu-Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seoung Hoon Kim
- Center for Liver Cancer, National Cancer Center, Goyang, Korea
| | - Hyung Il Seo
- Department of Surgery, Pusan National University Hospital, Busan, Korea
| | - Je Ho Ryu
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | | | | | | | - Haeshin Lee
- R&D Center, InnoTherapy Inc., Seoul, Korea.,Department of Chemistry, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Korea
| | - Jae Hun Kim
- Department of Trauma Surgery and Surgical Critical Care, Pusan National University Hospital, Busan, Korea.,Department of Surgery, Pusan National University College of Medicine, Busan, Korea
| |
Collapse
|
7
|
Iannitti DA, Kim C, Ito D, Epstein J. Impact of an active hemostatic product treatment approach on bleeding-related complications and hospital costs among inpatient surgeries in the United States. J Med Econ 2021; 24:514-523. [PMID: 33858281 DOI: 10.1080/13696998.2021.1916751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIMS To examine the impact of active only (A) vs. combined passive and active (PA) hemostatic products on bleeding-related complications and costs among inpatient surgeries. MATERIALS AND METHODS This retrospective analysis of the US Premier Hospital Database included patients who had an inpatient procedure within a specialty of interest (cardiac, vascular, noncardiac thoracic, solid organ, general, reproductive organ, knee/hip replacement, spinal, or neurosurgery) that utilized a hemostatic product from January 1, 2017 to December 31, 2018. Patients were directly matched 1:1 on surgery code, age categories, and Charlson Comorbidity Index score categories into A or PA cohorts. Unadjusted and adjusted rates of bleeding-related complications, length of stay (LOS) and total hospital costs were compared between cohorts. RESULTS A total of 5,934 cardiac, 7,986 vascular, 2,042 noncardiac thoracic, 8,260 solid organ, 9,502 general, 4,616 reproductive organ, 2,758 knee/hip replacement, 42,648 spinal, and 10,716 neuro surgeries were included. Higher unadjusted rates of bleeding-related complications and greater LOS and total hospital costs were observed in the PA cohort vs A cohort across all specialties. The adjusted odds of bleeding complications were significantly higher in solid organ, general, knee/hip replacement, reproductive organ, and spinal surgery (OR range = 1.17-2.48, all p <.01), while incremental costs per hospitalization associated with PA (vs A) controlling for covariates were higher across all specialties (ratio range = 1.04-1.22, all p <.05). LIMITATIONS This analysis focused on patients who had a single surgery during the hospital encounter; results may not be generalizable to patients undergoing multiple surgeries. CONCLUSIONS The use of A hemostatic products was associated with significantly lower rates of bleeding-related complications and total hospital costs compared to PA hemostatic products. A treatment approach which considers bleeding-related factors including severity, risk and variability based on surgery type may provide guidance in choosing the optimal hemostatic product to improve surgical outcomes and costs.
Collapse
|
8
|
Topical Hemostatic Agents at Time of Obstetric and Gynecologic Surgery: ACOG Committee Opinion, Number 812. Obstet Gynecol 2020; 136:e81-e89. [PMID: 32976379 DOI: 10.1097/aog.0000000000004104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There are three broad categories of hemostatic agents: 1) caustic, 2) physical, and 3) biologic. Because of the paucity of data on the use of topical hemostatic agents in gynecologic and obstetric surgery, indications for use are extrapolated from data on the use of these agents in other types of surgeries and are based on expert opinion. Topical hemostatic agents can be a useful adjunct to assist in the management of intraoperative bleeding in select circumstances. Topical hemostatic agents most commonly are used in situations where the use of electrocautery or sutures for hemostatic control of surgical bleeding is not ideal or safe, including bleeding in areas with nearby vulnerable structures or in the presence of diffuse bleeding from peritoneal surfaces or cut surfaces of solid organs. When managing intraoperative bleeding, there is no substitute for meticulous surgical technique. When possible, the surgeon should attempt to control intraoperative bleeding with sutures, clips, or electrosurgery before the use of hemostatic agents. It is essential for surgeons to understand the appropriate use, contraindications, and cost of these agents in order to make the most informed decision for patient care.
Collapse
|
9
|
Paternò VA, Bisin A, Addis A. Comparison of the efficacy of five standard topical hemostats: a study in porcine liver and spleen models of surgical bleeding. BMC Surg 2020; 20:215. [PMID: 32977788 PMCID: PMC7519517 DOI: 10.1186/s12893-020-00874-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/20/2020] [Indexed: 11/19/2022] Open
Abstract
Background Several topical hemostats are available to help control surgical bleeding. Cutanplast is a highly absorbent and porous gelatin product that is available in Fast sponge and powder forms. This study investigated the hemostatic efficacy of Cutanplast Standard and Fast gelatin sponge and powder and Emosist oxidized regenerated cellulose (ORC) gauze in porcine liver and spleen surgical bleeding models. Methods Cutanplast Standard and Fast gelatin sponge and Emosist ORC gauze were tested in liver abrasion/incision, liver puncture and spleen incision/puncture injuries, and Cutanplast Standard and Fast gelatin powder products were tested in liver abrasion/incision injuries. There were 13 liver injury (five abrasion, five incision and three puncture) and six spleen injury (three puncture and three incision sites) sites per animal. Results Rapid hemostasis (≤ 2–5 min) was achieved in the liver abrasion and incision models with all Cutanplast gelatin sponge and powder products and Emosist ORC gauze, except in the liver incision model, time to hemostasis was > 5 min with Cutanplast Standard gelatin powder and Emosist ORC gauze. Rapid hemostasis occurred with Cutanplast Fast gelatin sponge and Emosist ORC gauze in the liver puncture and spleen puncture and incision models. In the spleen incision model, Cutanplast Standard gelatin sponge had a time to hemostasis approaching 10 min. Conclusion Cutanplast gelatin sponge and powder products and Emosist ORC gauze may be suitable for surgical applications involving parenchymal organ bleeding, but certain products may perform better than others, including Cutanplast gelatin powder in diffuse mild bleeding (such as liver abrasion), and Cutanplast Fast gelatin sponge and Emosist ORC gauze for splenic bleeding.
Collapse
|
10
|
Medvecz A, Bernard A, Hamilton C, Schuster KM, Guillamondegui O, Davenport D. Transfusion rates in emergency general surgery: high but modifiable. Trauma Surg Acute Care Open 2020; 5:e000371. [PMID: 32154373 PMCID: PMC7046949 DOI: 10.1136/tsaco-2019-000371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 12/13/2019] [Accepted: 12/18/2019] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Transfusion of red blood cells (RBC) increases morbidity and mortality, and emergency general surgery (EGS) cases have increased risk for transfusion and complication given case complexity and patient acuity. Transfusion reduction strategies and blood-conservation technology have been developed to decrease transfusions. This study explores whether transfusion rates in EGS have decreased as these new strategies have been implemented. METHODS This is a retrospective review of the American College of Surgeons' National Surgical Quality Improvement Program (ACS NSQIP) data from three academic medical centers. Operations performed by general surgeons on adults (aged ≥18 years) were selected. Data were analyzed from two periods: 2011-2013 and 2014-2016. Cases were grouped by the first four digits of the primary procedure Current Procedural Terminology code. Transfusion was defined as any RBC transfusion during or within 72 hours following the operation. Composite morbidity was defined as any NSQIP complication within 30 days following the operation. RESULTS Overall general surgery transfusion rates decreased from 6.4% to 4.8% from period 1 to period 2 (emergent: 16.6%-11.5%; non-emergent 4.9%-3.7%; Fisher's exact p values <0.001). Among patients transfused, the number of units received decreased slightly (median 2 U (IQR 2-3) to median 2 U (IQR 1-3), Mann-Whitney U test p=0.005). Morbidity decreased (overall: 13.8%-12.3%, p=0.001; emergent: 26.3%-20.6%, p<0.001) while mortality did not change. DISCUSSION Rates of RBC transfusion decreased in both emergent and non-emergent cases. Efforts to reduce transfusion may have been successful in the EGS population. Morbidity improved over the time periods while mortality was unchanged. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Andrew Medvecz
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Andrew Bernard
- Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Courtney Hamilton
- Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Kevin M Schuster
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Oscar Guillamondegui
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Daniel Davenport
- Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| |
Collapse
|
11
|
Shen J, Nada AA, Abou-Zeid NY, Hudson SM. Synthesis of chitosan iodoacetamides via carbodiimide coupling reaction: Effect of degree of substitution on the hemostatic properties. Carbohydr Polym 2020; 229:115522. [DOI: 10.1016/j.carbpol.2019.115522] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 08/23/2019] [Accepted: 10/22/2019] [Indexed: 11/16/2022]
|
12
|
Tan GM, Guinn NR, Frank SM, Shander A. Proceedings From the Society for Advancement of Blood Management Annual Meeting 2017: Management Dilemmas of the Surgical Patient-When Blood Is Not an Option. Anesth Analg 2019; 128:144-151. [PMID: 29958216 DOI: 10.1213/ane.0000000000003478] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Vigilance is essential in the perioperative period. When blood is not an option for the patient, especially in a procedure/surgery that normally holds a risk for blood transfusion, complexity is added to the management. Current technology and knowledge has made avoidance of blood transfusion a realistic option but it does require a concerted patient-centered effort from the perioperative team. In this article, we provide suggestions for a successful, safe, and bloodless journey for patients. The approaches include preoperative optimization as well as intraoperative and postoperative techniques to reduce blood loss, and also introduces current innovative substitutes for transfusions. This article also assists in considering and maneuvering through the legal and ethical systems to respect patients' beliefs and ensuring their safety.
Collapse
Affiliation(s)
- Gee Mei Tan
- From the Department of Anesthesiology, University of Colorado, School of Medicine, Aurora, Colorado
| | - Nicole R Guinn
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Steven M Frank
- Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Aryeh Shander
- Department of Anesthesiology and Critical Care Medicine, Englewood Hospital and Medical Center and TeamHealth Research Institute, Englewood, New Jersey
| |
Collapse
|
13
|
Cholette JM, Faraoni D, Goobie SM, Ferraris V, Hassan N. Patient Blood Management in Pediatric Cardiac Surgery: A Review. Anesth Analg 2019; 127:1002-1016. [PMID: 28991109 DOI: 10.1213/ane.0000000000002504] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Efforts to reduce blood product transfusions and adopt blood conservation strategies for infants and children undergoing cardiac surgical procedures are ongoing. Children typically receive red blood cell and coagulant blood products perioperatively for many reasons, including developmental alterations of their hemostatic system, and hemodilution and hypothermia with cardiopulmonary bypass that incites inflammation and coagulopathy and requires systemic anticoagulation. The complexity of their surgical procedures, complex cardiopulmonary interactions, and risk for inadequate oxygen delivery and postoperative bleeding further contribute to blood product utilization in this vulnerable population. Despite these challenges, safe conservative blood management practices spanning the pre-, intra-, and postoperative periods are being developed and are associated with reduced blood product transfusions. This review summarizes the available evidence regarding anemia management and blood transfusion practices in the perioperative care of these critically ill children. The evidence suggests that adoption of a comprehensive blood management approach decreases blood transfusions, but the impact on clinical outcomes is less well studied and represents an area that deserves further investigation.
Collapse
Affiliation(s)
- Jill M Cholette
- From the Department of Pediatrics, Golisano Children's Hospital, University of Rochester, Rochester, New York
| | - David Faraoni
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Susan M Goobie
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston, Massachusetts.,Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Victor Ferraris
- Department of Surgery, University of Kentucky Chandler Medical Center & Lexington Veterans Affairs Medical Center, Lexington, Kentucky
| | - Nabil Hassan
- Division of Pediatric Critical Care, Children's Hospital of Illinois At OSF St Frances, University of Illinois at Peoria, Peoria, Illinois
| |
Collapse
|
14
|
Liang Y, Xu C, Liu F, Du S, Li G, Wang X. Eliminating Heat Injury of Zeolite in Hemostasis via Thermal Conductivity of Graphene Sponge. ACS APPLIED MATERIALS & INTERFACES 2019; 11:23848-23857. [PMID: 31245992 DOI: 10.1021/acsami.9b04956] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Thermal release of zeolite is conducive in hemostasis, but losing control will cause serious burns. How to balance the advantages and disadvantages is a challenge. Herein, a zeolite/cross-linked graphene sponge (Z-CGS) was design to break through this challenge. The CGS managed the heat release of zeolite by thermal conduction of graphene. Infrared thermal imager demonstrated the mild exothermic process and good thermal conductivity of the optimized Z-CGS. It controlled wound temperature below 42 °C effectively, as compared to 70 °C of naked zeolite. Blood clotting index further confirmed the contribution of thermal stimulation in Z-CGS. On the synergy of thermal and charge stimulations of zeolite, as well as physical adsorption of CGS, Z-CGS achieved outstanding hemostatic performance. Bleeding was stopped within 69 s in rat artery injury model, faster than that of the Quikclot Combat Gauze. Additionally, cytotoxicity assay and pathological analysis highlighted its biocompatibility. Z-CGS, therefore, was an outstanding composite of combining advantages of zeolite and graphene, while getting rid of the shortcomings of the basic unit. The thermal conductibility of graphene renews an avenue for the safe and highly efficient use of zeolite in hemostasis.
Collapse
Affiliation(s)
- Yuping Liang
- Beijing Laboratory of Biomedical Materials , Beijing University of Chemical Technology , Beijing 100029 , P. R. China
| | - Congcong Xu
- Beijing Laboratory of Biomedical Materials , Beijing University of Chemical Technology , Beijing 100029 , P. R. China
| | - Fang Liu
- Department of Gastroenterology , China-Japan Friendship Hospital , Beijing 100029 , P. R. China
| | - Shiyu Du
- Department of Gastroenterology , China-Japan Friendship Hospital , Beijing 100029 , P. R. China
| | - Guofeng Li
- Beijing Laboratory of Biomedical Materials , Beijing University of Chemical Technology , Beijing 100029 , P. R. China
- Key Laboratory of Biomedical Materials of Natural Macromolecules , Beijing University of Chemical Technology, Ministry of Education , Beijing 100029 , P. R. China
| | - Xing Wang
- Beijing Laboratory of Biomedical Materials , Beijing University of Chemical Technology , Beijing 100029 , P. R. China
- Key Laboratory of Biomedical Materials of Natural Macromolecules , Beijing University of Chemical Technology, Ministry of Education , Beijing 100029 , P. R. China
| |
Collapse
|
15
|
Komarov RN, Karavaĭkin PA, Kuznetsov AA, Shcherbenev VM, Bredikhin RA, Gnevashev AS, Iudin AN, Tsekhanovich VN, Andreev DB. [Use of topical haemostatic agents in cardiovascular surgery]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2019; 25:131-142. [PMID: 30994619 DOI: 10.33529/angio2019118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The problem of haemostasis in cardiovascular surgery is of current concern. Recent trends are towards increased use of topical haemostatic agents. Tachocomb has been used for more than 30 years in abdominal surgery and oncology. The purpose of the present publication is to analyse the literature data and formulate the indications for the use of Tachocomb in cardiovascular surgery. Multicenter randomized and local studies have demonstrated efficacy of Tachocomb in treatment of surgical haemorrhage in operations on the heart, thoracic aorta, carotid arteries and lower-limb arteries, resulting in significantly decreased time to achieve haemostasis, decreased volume of blood loss and haemotrasfusion, as well as reduced frequency of complications. Also shown was economic efficacy, including a shortened length of patients' hospital stay. This is followed by describing a wide spectrum of examples of alternative use of Tachocomb, including its use for seamless closure of defects of cardiac chamber walls, aero- and lymphostasis, prevention of formation of commissures. Convincing experimental and clinical results make it possible to formulate a series of indications for the use of Tachocomb in cardiovascular surgery.
Collapse
Affiliation(s)
- R N Komarov
- Clinic of Aortic and Cardiovascular Surgery, Chair of Hospital Surgery of Therapeutic Department, First Moscow State Medical University named after I.M. Sechenov under the RF Ministry of Public Health, Moscow, Russia
| | - P A Karavaĭkin
- Clinic of Aortic and Cardiovascular Surgery, Chair of Hospital Surgery of Therapeutic Department, First Moscow State Medical University named after I.M. Sechenov under the RF Ministry of Public Health, Moscow, Russia
| | - A A Kuznetsov
- Central Military Clinical Hospital named after A.A. Vishnevsky of the RF Ministry of Defence, Moscow, Russia
| | | | - R A Bredikhin
- Interregional Clinical and Diagnostic Centre, Kazan, Russia
| | - A S Gnevashev
- North-West Federal Medical Research Centre named after V.A. Almazov under the RF Ministry of Public Health, Saint Petersburg, Russia
| | - A N Iudin
- Ulyanovsk Regional Clinical Hospital, Ulyanovsk, Russia
| | | | - D B Andreev
- Federal Centre of Cardiovascular Surgery under the RF Ministry of Public Health, Khabarovsk, Russia
| |
Collapse
|
16
|
Centeno A, Rojas S, Arias B, Miquel I, Sánchez P, Ureta C, Rincón E, López R, Murat J. Experimental Evaluation of a New Tissue Factor-Based Topical Hemostat (TT-173) for Treatment of Hepatic Bleeding. J INVEST SURG 2018; 33:339-349. [DOI: 10.1080/08941939.2018.1517840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Alberto Centeno
- Unit of Experimental Surgery, Institute of Biomedical Investigation of A Coruña, Xubias de Arriba, 84, A Coruña 15006, Spain
| | - Santiago Rojas
- Thombotargets Europe S.L. Mediterranean Technology Park, Av. Canal Olímpic, s/n, Edif, B 6, 2ª, Castelldefels 08860, Spain
- Unit of Human Anatomy and Embryology, Department of Morphological Sciences, Faculty of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès 08193, Spain
| | - Belén Arias
- Thombotargets Europe S.L. Mediterranean Technology Park, Av. Canal Olímpic, s/n, Edif, B 6, 2ª, Castelldefels 08860, Spain
| | - Ignasi Miquel
- Thombotargets Europe S.L. Mediterranean Technology Park, Av. Canal Olímpic, s/n, Edif, B 6, 2ª, Castelldefels 08860, Spain
| | - Pilar Sánchez
- Thombotargets Europe S.L. Mediterranean Technology Park, Av. Canal Olímpic, s/n, Edif, B 6, 2ª, Castelldefels 08860, Spain
| | - Claudia Ureta
- Thombotargets Europe S.L. Mediterranean Technology Park, Av. Canal Olímpic, s/n, Edif, B 6, 2ª, Castelldefels 08860, Spain
| | - Esther Rincón
- Thombotargets Europe S.L. Mediterranean Technology Park, Av. Canal Olímpic, s/n, Edif, B 6, 2ª, Castelldefels 08860, Spain
| | - Ramón López
- Thombotargets Europe S.L. Mediterranean Technology Park, Av. Canal Olímpic, s/n, Edif, B 6, 2ª, Castelldefels 08860, Spain
| | - Jesús Murat
- Thombotargets Europe S.L. Mediterranean Technology Park, Av. Canal Olímpic, s/n, Edif, B 6, 2ª, Castelldefels 08860, Spain
| |
Collapse
|
17
|
Liang Y, Xu C, Li G, Liu T, Liang JF, Wang X. Graphene-kaolin composite sponge for rapid and riskless hemostasis. Colloids Surf B Biointerfaces 2018; 169:168-175. [DOI: 10.1016/j.colsurfb.2018.05.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 05/05/2018] [Accepted: 05/07/2018] [Indexed: 11/16/2022]
|
18
|
Stone Ii R, Natesan S, Kowalczewski CJ, Mangum LH, Clay NE, Clohessy RM, Carlsson AH, Tassin DH, Chan RK, Rizzo JA, Christy RJ. Advancements in Regenerative Strategies Through the Continuum of Burn Care. Front Pharmacol 2018; 9:672. [PMID: 30038569 PMCID: PMC6046385 DOI: 10.3389/fphar.2018.00672] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/05/2018] [Indexed: 01/09/2023] Open
Abstract
Burns are caused by several mechanisms including flame, scald, chemical, electrical, and ionizing and non-ionizing radiation. Approximately half a million burn cases are registered annually, of which 40 thousand patients are hospitalized and receive definitive treatment. Burn care is very resource intensive as the treatment regimens and length of hospitalization are substantial. Burn wounds are classified based on depth as superficial (first degree), partial-thickness (second degree), or full-thickness (third degree), which determines the treatment necessary for successful healing. The goal of burn wound care is to fully restore the barrier function of the tissue as quickly as possible while minimizing infection, scarring, and contracture. The aim of this review is to highlight how tissue engineering and regenerative medicine strategies are being used to address the unique challenges of burn wound healing and define the current gaps in care for both partial- and full-thickness burn injuries. This review will present the current standard of care (SOC) and provide information on various treatment options that have been tested pre-clinically or are currently in clinical trials. Due to the complexity of burn wound healing compared to other skin injuries, burn specific treatment regimens must be developed. Recently, tissue engineering and regenerative medicine strategies have been developed to improve skin regeneration that can restore normal skin physiology and limit adverse outcomes, such as infection, delayed re-epithelialization, and scarring. Our emphasis will be centered on how current clinical and pre-clinical research of pharmacological agents, biomaterials, and cellular-based therapies can be applied throughout the continuum of burn care by targeting the stages of wound healing: hemostasis, inflammation, cell proliferation, and matrix remodeling.
Collapse
Affiliation(s)
- Randolph Stone Ii
- Combat Trauma and Burn Injury Research, US Army Institute of Surgical Research San Antonio, TX, United States
| | - Shanmugasundaram Natesan
- Combat Trauma and Burn Injury Research, US Army Institute of Surgical Research San Antonio, TX, United States
| | - Christine J Kowalczewski
- Combat Trauma and Burn Injury Research, US Army Institute of Surgical Research San Antonio, TX, United States
| | - Lauren H Mangum
- Combat Trauma and Burn Injury Research, US Army Institute of Surgical Research San Antonio, TX, United States.,Extremity Trauma and Regenerative Medicine, US Army Institute of Surgical Research San Antonio, TX, United States
| | - Nicholas E Clay
- Combat Trauma and Burn Injury Research, US Army Institute of Surgical Research San Antonio, TX, United States
| | - Ryan M Clohessy
- Combat Trauma and Burn Injury Research, US Army Institute of Surgical Research San Antonio, TX, United States
| | - Anders H Carlsson
- Dental and Craniofacial Trauma Research, US Army Institute of Surgical Research San Antonio, TX, United States
| | - David H Tassin
- Dental and Craniofacial Trauma Research, US Army Institute of Surgical Research San Antonio, TX, United States
| | - Rodney K Chan
- Dental and Craniofacial Trauma Research, US Army Institute of Surgical Research San Antonio, TX, United States
| | - Julie A Rizzo
- Burn Flight Team, US Army Institute of Surgical Research San Antonio, TX, United States
| | - Robert J Christy
- Combat Trauma and Burn Injury Research, US Army Institute of Surgical Research San Antonio, TX, United States
| |
Collapse
|
19
|
Giritharan S, Salhiyyah K, Tsang GM, Ohri SK. Feasibility of a novel, synthetic, self-assembling peptide for suture-line haemostasis in cardiac surgery. J Cardiothorac Surg 2018; 13:68. [PMID: 29903028 PMCID: PMC6003074 DOI: 10.1186/s13019-018-0745-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 05/31/2018] [Indexed: 11/13/2022] Open
Abstract
Backgroud To assess the feasibility and efficacy of PuraStat®, a novel haemostatic agent, in achieving suture line haemostasis in a wide range of cardiac surgical procedures and surgery of the thoracic aorta. Methods A prospective, non-randomised study was conducted at our institution. Operative data on fifty consecutive patients undergoing cardiac surgery where PuraStat® was utilised in cases of intraoperative suture line bleeding was prospectively collected. Questionnaires encompassing multiple aspects of the ease of use and efficacy of PuraStat® were completed by ten surgeons (five consultants and five senior registrars) and analysed to gauge the performance of the product. Results No major adverse cardiac events were reported in this cohort. Complications such as atrial fibrillation, pacemaker requirement and pleural effusions were comparable to the national average. Mean blood product use of packed red cells, platelets, fresh-frozen plasma (FFP) and cryoprecipitate was below the national average. There was one incidence of re-exploration, however this was due to pericardial constriction rather than bleeding. Analysis of questionnaire responses revealed that surgeons consistently rated PuraStat® highly (between a score of 7 and 10 in the various subcategories). The transparent nature or PuraStat® allowed unobscured visualisation of suture sites and possessed excellent qualities in terms of adherence to site of application. The application of PuraStat® did not interfere with the use of other haemostatic agents or manipulation of the suture site by the surgeon. Conclusion PuraStat® is an easy-to-use and effective haemostatic agent in a wide range of cardiac and aortic surgical procedures.
Collapse
Affiliation(s)
- Suresh Giritharan
- Wessex Cardiac Centre, University Hospitals Southampton, Tremona Road, Southampton, SO16 6YD, UK. .,, Southampton, UK.
| | - Kareem Salhiyyah
- Wessex Cardiac Centre, University Hospitals Southampton, Tremona Road, Southampton, SO16 6YD, UK
| | - Geoffrey M Tsang
- Wessex Cardiac Centre, University Hospitals Southampton, Tremona Road, Southampton, SO16 6YD, UK
| | - Sunil K Ohri
- Wessex Cardiac Centre, University Hospitals Southampton, Tremona Road, Southampton, SO16 6YD, UK
| |
Collapse
|
20
|
Khoynezhad A, DelaRosa J, Moon MR, Brinkman WT, Thompson RB, Desai ND, Malaisrie SC, Girardi LN, Bavaria JE, Reece TB. Facilitating Hemostasis After Proximal Aortic Surgery: Results of The PROTECT Trial. Ann Thorac Surg 2018; 105:1357-1364. [DOI: 10.1016/j.athoracsur.2017.12.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 11/29/2017] [Accepted: 12/12/2017] [Indexed: 10/18/2022]
|
21
|
Glineur D, Hendrikx M, Krievins D, Stradins P, Voss B, Waldow T, Haenen L, Oberhoffer M, Ritchie CM. A randomized, controlled trial of Veriset™ hemostatic patch in halting cardiovascular bleeding. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2018; 11:65-75. [PMID: 29563844 PMCID: PMC5846302 DOI: 10.2147/mder.s145651] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Obtaining hemostasis during cardiovascular procedures can be a challenge, particularly around areas with a complex geometry or that are difficult to access. While several topical hemostats are currently on the market, most have caveats that limit their use in certain clinical scenarios such as pulsatile arterial bleeding. The aim of this study was to assess the effectiveness and safety of Veriset™ hemostatic patch in treating cardiovascular bleeding. Methods Patients (N=90) scheduled for cardiac or vascular surgery at 12 European institutions were randomized 1:1 to treatment with either Veriset™ hemostatic patch (investigational device) or TachoSil® (control). After application of the hemostat, according to manufacturer instructions for use, time to hemostasis was monitored. Follow-up occurred up to 90 days post-surgery. Results Median time to hemostasis was 1.5 min with Veriset™ hemostatic patch, compared to 3.0 min with TachoSil® (p<0.0001). Serious adverse events within 30 days post-surgery were experienced by 12/44 (27.3%) patients treated with Veriset™ hemostatic patch and 10/45 (22.2%) in the TachoSil® group (p=0.6295). None of these adverse events were device-related, and no reoperations for bleeding were required within 5 days post-surgery in either treatment group. Conclusion This study reinforces the difference in minimum recommended application time between Veriset™ hemostatic patch and TachoSil® (30 s versus 3 min respectively). When compared directly at 3 min, Veriset™ displayed no significant difference, showing similar hemostasis and safety profiles on the cardiovascular bleeding sites included in this study.
Collapse
Affiliation(s)
- David Glineur
- Saint Luc Cliniques Universitaires, Brussels, Belgium
| | - Marc Hendrikx
- Faculty of Medicine and Life Sciences, Jessa Hospital, Hasselt University, Hasselt, Belgium
| | | | | | - Bernhard Voss
- German Heart Center Munich, Department of Cardiovascular Surgery, Technische Universität München, Munich, Germany
| | - Thomas Waldow
- Heart Center Dresden GmbH, University Hospital Dresden, Dresden, Germany
| | | | - Martin Oberhoffer
- Asklepios Klinik St. Georg, Herzchirurgische Abteilung, Hamburg, Germany
| | | |
Collapse
|
22
|
Takagi T, Tsujimoto H, Torii H, Ozamoto Y, Hagiwara A. Two-layer sheet of gelatin: A new topical hemostatic agent. Asian J Surg 2018; 41:124-130. [DOI: 10.1016/j.asjsur.2016.09.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 08/30/2016] [Accepted: 09/07/2016] [Indexed: 10/20/2022] Open
|
23
|
Pikoulis E, Salem KM, Avgerinos ED, Pikouli A, Angelou A, Pikoulis A, Georgopoulos S, Karavokyros I. Damage Control for Vascular Trauma from the Prehospital to the Operating Room Setting. Front Surg 2017; 4:73. [PMID: 29312951 PMCID: PMC5742177 DOI: 10.3389/fsurg.2017.00073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 11/20/2017] [Indexed: 01/12/2023] Open
Abstract
Early management of vascular injury, starting at the field, is imperative for survival no less than any operative maneuver. Contemporary prehospital management of vascular trauma, including appropriate fluid and volume infusion, tourniquets, and hemostatic agents, has reversed the historically known limb hemorrhage as a leading cause of death. In this context, damage control (DC) surgery has evolved to DC resuscitation (DCR) as an overarching concept that draws together preoperative and operative interventions aiming at rapidly reducing bleeding from vascular disruption, optimizing oxygenation, and clinical outcomes. This review addresses contemporary DCR techniques from the prehospital to the surgical setting, focusing on civilian vascular injuries.
Collapse
Affiliation(s)
- Emmanouil Pikoulis
- 1st Department of Surgery, Laiko Hospital, School of Medicine, University of Athens, Athens, Greece
| | - Karim M Salem
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Efthymios D Avgerinos
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Anastasia Pikouli
- 1st Department of Surgery, Laiko Hospital, School of Medicine, University of Athens, Athens, Greece
| | - Anastasios Angelou
- 1st Department of Surgery, Laiko Hospital, School of Medicine, University of Athens, Athens, Greece
| | - Antreas Pikoulis
- 1st Department of Surgery, Laiko Hospital, School of Medicine, University of Athens, Athens, Greece
| | - Sotirios Georgopoulos
- 1st Department of Surgery, Laiko Hospital, School of Medicine, University of Athens, Athens, Greece
| | - Ioannis Karavokyros
- 1st Department of Surgery, Laiko Hospital, School of Medicine, University of Athens, Athens, Greece
| |
Collapse
|
24
|
Meybohm P, Froessler B, Goodnough LT, Klein AA, Muñoz M, Murphy MF, Richards T, Shander A, Spahn DR, Zacharowski K. "Simplified International Recommendations for the Implementation of Patient Blood Management" (SIR4PBM). Perioper Med (Lond) 2017; 6:5. [PMID: 28331607 PMCID: PMC5356305 DOI: 10.1186/s13741-017-0061-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 02/23/2017] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND More than 30% of the world's population are anemic with serious medical and economic consequences. Red blood cell transfusion is the mainstay to correct anemia, but it is also one of the top five overused procedures and carries its own risk and cost burden. Patient blood management (PBM) is a patient-centered and multidisciplinary approach to manage anemia, minimize iatrogenic blood loss, and harness tolerance to anemia in an effort to improve patient outcome. Despite resolution 63.12 of the World Health Organization in 2010 endorsing PBM and current guidelines which include evidence-based recommendations on the use of diagnostic/therapeutic resources to provide better health care, many hospitals have yet to implement PBM in routine clinical practice. METHOD AND RESULTS A number of experienced clinicians developed the following "Simplified International Recommendations for Patient Blood Management." We propose a series of simple, cost-effective, best-practice, feasible, and evidence-based measures that will enable any hospital to reduce both anemia prevalence on the day of intervention/surgery and anemia-related unnecessary transfusion in surgical and medical patients, including obstetrics and gynecology.
Collapse
Affiliation(s)
- Patrick Meybohm
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Bernd Froessler
- Department of Anaesthesia, Lyell McEwin Hospital, South Australia, Australia
| | | | - Andrew A. Klein
- Department of Anaesthesia and Intensive Care, Papworth Hospital, Cambridge, UK
| | - Manuel Muñoz
- Transfusion Medicine, School of Medicine, University of Málaga, Málaga, Spain
| | - Michael F. Murphy
- NHS Blood and Transplant, Oxford University Hospitals NHS Foundation Trust, University of Oxford, Oxford, UK
| | - Toby Richards
- Centre for CardioVascular and Interventional Research (CAVIAR), University College London, Rockerfellow Building, University Street, London, UK
| | - Aryeh Shander
- Department of Anaesthesiology and Critical Care and Hyperbaric Medicine, Englewood Hospital and Medical Center, TeamHealth Research Institute, Englewood, NJ USA
| | - Donat R. Spahn
- Institute of Anaesthesiology, University of Zurich and University Hospital of Zurich, Zurich, Switzerland
| | - Kai Zacharowski
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| |
Collapse
|
25
|
Gleva MJ, Poole JE. Prevention of Cardiac Implantable Electronic Device Infections: Update and Evaluation of the Potential Role for Capsulectomy or the Antibiotic Pouch. J Atr Fibrillation 2017; 9:1540. [PMID: 29250274 PMCID: PMC5673390 DOI: 10.4022/jafib.1540] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 01/18/2017] [Accepted: 01/24/2017] [Indexed: 11/10/2022]
Abstract
Cardiac implantable electronic device (CIED) infections can have devastating implications for patient morbidity and mortality. Over the past decade, the infection rate has risen out of proportion to implant rates, and has prompted the development of innovative solutions designed to reduce infections. The first section of this review provides a summary of the contemporary knowledge regarding the incidence, prevalence, microbiology, and risk factors for cardiac implantable electronic device infections. The second section addresses prevention with an emphasis on the potential role of novel procedural approaches, such as capsulectomy and the antibacterial envelope, in reducing CIED infection.
Collapse
Affiliation(s)
- Marye J Gleva
- Washington University in St. Louis School of Medicine, St. Louis,MO
| | | |
Collapse
|
26
|
Abstract
PURPOSE OF REVIEW Death from exsanguinating hemorrhage remains a priority in the management of combat casualties and civilian trauma patients with truncal and junctional injuries. Appropriate use of hemostatic agents and dressings in the prehospital setting may allow for earlier control and an improved survival rate. RECENT FINDINGS Third-generation chitosan-based hemostatic agents and dressings appear to be equally efficacious to the dressing currently deployed by the US military forces in the management of hemorrhage not amenable to tourniquet placement. Unfortunately, a lack of clinical trials places a heavy reliance on anecdotal reports and laboratory studies in agent selection and application. SUMMARY Efficacy of currently available hemostatic agents and dressings appears to have plateaued in recent years although new agents and delivery mechanisms under development may improve control in cases of severe hemorrhage.
Collapse
|
27
|
Xia Q, Liu Z, Wang C, Zhang Z, Xu S, Han CC. A Biodegradable Trilayered Barrier Membrane Composed of Sponge and Electrospun Layers: Hemostasis and Antiadhesion. Biomacromolecules 2015; 16:3083-92. [DOI: 10.1021/acs.biomac.5b01099] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Qinghua Xia
- State
Key Laboratory of Polymer Physics and Chemistry, Joint Laboratory
of Polymer Science and Materials, Beijing National Laboratory for
Molecular Sciences, Institute of Chemistry, Chinese Academy of Sciences, Beijing 100190, P. R. China
- University of Chinese Academy of Sciences, Beijing 100049, P. R. China
| | - Ziwen Liu
- Department
of General Surgery, Peking Union Medical College Hospital, Chinese
Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, P. R. China
| | - Chenhong Wang
- State
Key Laboratory of Polymer Physics and Chemistry, Joint Laboratory
of Polymer Science and Materials, Beijing National Laboratory for
Molecular Sciences, Institute of Chemistry, Chinese Academy of Sciences, Beijing 100190, P. R. China
- University of Chinese Academy of Sciences, Beijing 100049, P. R. China
| | - Zixin Zhang
- State
Key Laboratory of Polymer Physics and Chemistry, Joint Laboratory
of Polymer Science and Materials, Beijing National Laboratory for
Molecular Sciences, Institute of Chemistry, Chinese Academy of Sciences, Beijing 100190, P. R. China
- University of Chinese Academy of Sciences, Beijing 100049, P. R. China
| | - Shanshan Xu
- State
Key Laboratory of Polymer Physics and Chemistry, Joint Laboratory
of Polymer Science and Materials, Beijing National Laboratory for
Molecular Sciences, Institute of Chemistry, Chinese Academy of Sciences, Beijing 100190, P. R. China
| | - Charles C. Han
- State
Key Laboratory of Polymer Physics and Chemistry, Joint Laboratory
of Polymer Science and Materials, Beijing National Laboratory for
Molecular Sciences, Institute of Chemistry, Chinese Academy of Sciences, Beijing 100190, P. R. China
| |
Collapse
|
28
|
Gupta N, Chetter I, Hayes P, O-Yurvati AH, Moneta GL, Shenoy S, Pribble JP, Zuckerman LA. Randomized trial of a dry-powder, fibrin sealant in vascular procedures. J Vasc Surg 2015; 62:1288-95. [PMID: 26254451 DOI: 10.1016/j.jvs.2015.05.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 05/15/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Topical hemostats are important adjuncts for stopping surgical bleeding. The safety and efficacy of Fibrocaps, a dry-powder, fibrin sealant containing human plasma-derived thrombin and fibrinogen, was evaluated in patients undergoing vascular surgical procedures. METHODS In this single-blind trial (clinicaltrials.gov: NCT01527357), adult patients were randomized 2:1 to Fibrocaps plus gelatin sponge (Fibrocaps) vs gelatin sponge alone. Results are presented for the patient subset undergoing vascular procedures with suture hole bleeding. The primary efficacy endpoint compared time to hemostasis (TTH) over 5 minutes. Safety follow-up continued to day 29. RESULTS A total of 175 patients were randomized and treated (Fibrocaps, 117; gelatin sponge, 58). Patients were predominately male (69%) and underwent arterial bypass (81%), arteriovenous graft formation (9%), or carotid endarterectomy (9%). Fibrocaps significantly reduced TTH compared with gelatin sponge (hazard ratio [HR], 2.1; 95% confidence interval [CI], 1.5-3.1; median TTH, 2 minutes; 95% CI, 1.5-2.5 vs 4 minutes; 95% CI, 3.0-5.0; P < .002). Significant reductions were also observed in patients receiving concomitant antiplatelet agents alone (HR, 2.8; 95% CI, 1.0-7.4; P = .03; n = 33), anticoagulants alone (HR, 2.0; 95% CI, 1.0-4.0; P = .04; n = 43), or both antiplatelet agents and anticoagulants (Fibrocaps vs gelatin sponge, HR, 2.3; 95% CI, 1.2-4.3; P = .008; n = 65). Incidences of common adverse events (procedural pain, nausea, constipation) were generally comparable between treatment arms. Anti-thrombin antibodies developed in 2% of Fibrocaps-treated patients and no-gelatin-sponge patients. CONCLUSIONS Fibrocaps, a ready-to-use, dry-powder fibrin sealant, was well-tolerated and reduced TTH in patients undergoing vascular procedures, including those receiving antiplatelet agents and/or anticoagulants, demonstrating its safety and usefulness as an adjunct to hemostasis.
Collapse
Affiliation(s)
- NavYash Gupta
- Division of Vascular Surgery, NorthShore University HealthSystem, Skokie, Ill
| | - Ian Chetter
- Department of Vascular Surgery, University of Hull, East Yorkshire, United Kingdom
| | - Paul Hayes
- Department of Vascular Surgery, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Albert H O-Yurvati
- Department of Surgery, University of North Texas Health Science Center, Fort Worth, Tex
| | - Gregory L Moneta
- Division of Vascular Surgery, Oregon Health & Science University Hospital & Clinic, Portland, Ore
| | - Surendra Shenoy
- Division of General Surgery, Section of Transplantation Surgery, Washington University School of Medicine, St. Louis, Mo
| | | | | |
Collapse
|
29
|
|
30
|
Florek HJ, Brunkwall J, Orend KH, Handley I, Pribble J, Dieck R. Results from a First-in-Human Trial of a Novel Vascular Sealant. Front Surg 2015; 2:29. [PMID: 26191528 PMCID: PMC4486749 DOI: 10.3389/fsurg.2015.00029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 06/15/2015] [Indexed: 11/13/2022] Open
Abstract
Background Suture hole bleeding from synthetic grafts presents a hemostatic challenge. The designs of many vascular sealants are not optimal (non-adherence to wet surfaces, excessive swelling, inflexible). PreveLeak™ (formerly ArterX®) is a polyaldehyde–bovine serum albumin-based sealant whose efficacy, safety, and performance were evaluated in this first-in-human study. Materials and methods A prospective, single-arm, multicenter study was performed in patients undergoing open vascular reconstructions with prosthetic grafts. Sealant was applied to the suture line after completion of the anastomosis. The primary endpoint was the incidence of immediate sealing (without clinically significant bleeding) upon clamp release. Secondary endpoints were time to sealing, safety, and assessment of product performance. Results Fifty-six anastomoses were performed in 32 patients. Grafts were Dacron (66% of sites), polytetrafluoroethylene (PTFE; 32%), or both Dacron and PTFE (2%). The femoral artery was the most common site of anastomosis (41% of sites). Immediate sealing after clamp release was achieved at all anastomoses (100%); 93% had no bleeding and 7% had oozing. No rebleeding occurred during 10 min of observation. The three most common adverse events were graft or bypass occlusion (n = 5 patients), infection (n = 4), and seroma (n = 3); none were device related. The sealant was considered easy to apply, quickly forming a soft gel, and adhering to tissue and grafts. Conclusion PreveLeak effectively sealed anastomotic suture lines during vascular reconstruction procedures and was considered easy to use. Adverse events were consistent with those commonly observed in patients undergoing surgical procedures. These results provided the support for conducting a larger controlled clinical trial.
Collapse
Affiliation(s)
| | - Jan Brunkwall
- Department of Vascular and Endovascular Surgery, University Clinics, University of Cologne , Cologne , Germany
| | - Karl-Heinz Orend
- Department of Thoracic and Vascular Surgery, University of Ulm , Ulm , Germany
| | - Ian Handley
- Tenaxis Medical, Inc. , Mountain View, CA , USA
| | | | | |
Collapse
|
31
|
Skorpil J, Paraforos A, Mandak J, Cohn WE, Hajek T, Friedrich I. Effective and rapid sealing of coronary, aortic and atrial suture lines. Interact Cardiovasc Thorac Surg 2015; 20:720-4; discussion 724. [DOI: 10.1093/icvts/ivv061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 02/27/2015] [Indexed: 11/13/2022] Open
|