1
|
Torres-de la Roche LA, Catena U, Clark TJ, Devassy R, Leyland N, De Wilde RL. Perspectives in adhesion prevention in gynaecological surgery. Facts Views Vis Obgyn 2023; 15:291-296. [PMID: 38128088 PMCID: PMC10832654 DOI: 10.52054/fvvo.15.4.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Adhesions are a frequent, clinically relevant, and often costly complication of surgery that can develop in any body location regardless of the type of surgical procedure. Adhesions result from surgical trauma inducing inflammatory and coagulation processes and to date cannot be entirely prevented. However, the extent of adhesion formation can be reduced by using good surgical technique and the use of anti-inflammatory drugs, haemostats, and barrier agents. Strategies are needed in the short-, medium- and longer-term to improve the prevention of adhesions. In the short-term, efforts are needed to increase the awareness amongst surgeons and patients about the potential risks and burden of surgically induced adhesions. To aid this in the medium- term, a risk score to identify patients at high risk of adhesion formation is being developed and validated. Furthermore, available potentially preventive measures need to be highlighted. Both clinical and health economic evaluations need to be undertaken to support the broad adoption of such measures. In the longer- term, a greater understanding of the pathogenic processes leading to the formation of adhesions is needed to help identify effective, future treatments to reliably prevent adhesions from forming and lyse existing ones.
Collapse
|
2
|
Sánchez Del Valle FJ, De Nicolás L, Fernández G, Fernández P, Gómez E, Aranaz Corral I. Comparison of a gelatin thrombin versus a modified absorbable polymer as a unique treatment for severe hepatic hemorrhage in swine. Sci Rep 2023; 13:20854. [PMID: 38012204 PMCID: PMC10682395 DOI: 10.1038/s41598-023-41983-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 09/04/2023] [Indexed: 11/29/2023] Open
Abstract
There are many surgical techniques (packing, Pringle maneuver, etc.) and hemostatic agents to manage hepatic bleeding in trauma surgery. This study compares the effectiveness of two different types of hemostatic agents, one is an active flowable hemostat and the other is a passive hemostat made of modified absorbable polymers [MAP]. Both surgical technique and hemostatic agents can be used together as a means of controlling bleeding. We have hypothesized that a single hemostatic agent might be as effective as a unique hemostatic surgical technique. Twenty swine were prospectively randomized to receive either active Flowable (Floseal) or passive MAP powder (PerClot) hemostatic agents. We used a novel severe liver injury model that caused exsanguinating hemorrhage. The main outcome measure was total blood loss volume. The total volume of blood loss, from hepatic injury to minute 120, was significantly lower in the Flowable group (407.5 cm3; IqR: 195.0-805.0 cm3) compared to MAP group (1107.5 cm3; IqR: 822.5 to 1544.5 cm3) (Hodges-Lehmann median difference: - 645.0 cm3; 95% CI: - 1144.0 to - 280.0 cm3; p = 0.0087). The rate of blood loss was significantly lower in the flowable group compared with the MAP group as measured from time of injury to minutes 3, 9, 12, and 120 (except for 6 min). The mean arterial pressure gradually recovered in the flowable group by 24 h, whereas in the MAP group, the mean arterial pressure was consistently stayed below baseline values. Kaplan-Meier survival analysis indicated similar rates of death between study groups (Logrank test p = 0.3395). Both the flowable and the MAP hemostatic agents were able to effectively control surgical bleeding in a novel severe liver injury model, however, the flowable gelatin-thrombin agent provided quicker and better bleed control.
Collapse
Affiliation(s)
- Francisco José Sánchez Del Valle
- Central Hospital of Defense, General and Digestive Unit, Spanish Ministry of Defense, Glorieta del Ejército, 1, 28047, Madrid, Spain.
| | - Luis De Nicolás
- Central Hospital of Defense, General and Digestive Unit, Spanish Ministry of Defense, Glorieta del Ejército, 1, 28047, Madrid, Spain
| | - Guillermo Fernández
- Central Hospital of Defense, General and Digestive Unit, Spanish Ministry of Defense, Glorieta del Ejército, 1, 28047, Madrid, Spain
| | - Pedro Fernández
- Central Hospital of Defense, Unit of Surgical Research, Spanish Ministry of Defense, Madrid, Spain
| | | | | |
Collapse
|
3
|
Lee J, Park S, Le PT, Lee G, Lee HW, Yun G, Jeon J, Park J, Pham DT, Park YS, Lim H, Kim C, Hwang TS, Kim SW, Lim G. Peripheral Microneedle Patch for First-Aid Hemostasis. Adv Healthc Mater 2023; 12:e2201697. [PMID: 36538487 DOI: 10.1002/adhm.202201697] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/21/2022] [Indexed: 01/18/2023]
Abstract
Despite the minimized puncture sizes and high efficiency, microneedle (MN) patches have not been used to inject hemostatic drugs into bleeding wounds because they easily destroy capillaries when a tissue is pierced. In this study, a shelf-stable dissolving MN patch is developed to prevent rebleeding during an emergency treatment. A minimally and site-selectively invasive hemostatic drug delivery system is established by using a peripheral MN (p-MN) patch that does not directly intrude the wound site but enables topical drug absorption in the damaged capillaries. The invasiveness of MNs is histologically examined by using a bleeding liver of a Sprague-Dawley (SD) rat as an extreme wound model in vivo. The skin penetration force is quantified to demonstrate that the administration of the p-MN patch is milder than that of the conventional MN patch. Hemostatic performance is systematically studied by analyzing bleeding weight and time and comparing them with that of conventional hemostasis methods. The superior performance of a p-MN for the heparin-pretreated SD rat model is demonstrated by intravenous injection in vivo.
Collapse
Affiliation(s)
- Jungho Lee
- Department of Mechanical Engineering, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea
| | - Sebin Park
- Department of Mechanical Engineering, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea
| | - Phuong Thao Le
- School of Interdisciplinary Bioscience and Bioengineering, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea
| | - Geunho Lee
- Department of Mechanical Engineering, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea
| | - Hyoun Wook Lee
- Department of Pathology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, 51353, Republic of Korea
| | - Gaeun Yun
- Department of Mechanical Engineering, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea
| | - Juhyeong Jeon
- Department of Mechanical Engineering, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea
| | - Jeongwoo Park
- School of Interdisciplinary Bioscience and Bioengineering, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea.,Medical Device Innovation Center, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea
| | - Duy Tho Pham
- Department of Mechanical Engineering, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea.,Department of Emergency Medicine, College of Medicine, Chungnam National University, Daejeon, 35015, Republic of Korea
| | - Young Sook Park
- Department of Physical Rehabilitation Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, 51353, Republic of Korea
| | - Hoon Lim
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, 14584, Republic of Korea
| | - Chulhong Kim
- Department of Mechanical Engineering, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea.,School of Interdisciplinary Bioscience and Bioengineering, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea.,Medical Device Innovation Center, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea.,Department of Convergence IT Engineering, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea.,Department of Electrical Engineering, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea
| | - Tae Sik Hwang
- Department of Emergency Medicine, Yonsei University College of Medicine, Yongin Severance Hospital, Yongin, 16995, Republic of Korea
| | - Seung Whan Kim
- Department of Emergency Medicine, College of Medicine, Chungnam National University, Daejeon, 35015, Republic of Korea
| | - Geunbae Lim
- Department of Mechanical Engineering, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea.,School of Interdisciplinary Bioscience and Bioengineering, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea.,Institute for Convergence Research and Education in Advanced Technology, Yonsei University, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| |
Collapse
|
4
|
José SDVF, Luis DN, Juan GM, Antonio DP, Lidia SR. Utility of microporous polysaccharide hemospheres in severe hepatic trauma: Experimental study of hemostatic strength and ease of use. Injury 2023; 54:339-344. [PMID: 36496265 DOI: 10.1016/j.injury.2022.11.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/11/2022] [Accepted: 11/16/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Animal studies confirm the utility of hemostatics against standard packing following severe liver injury. We investigated the efficacy and ease of use of novel microporous polysaccharide hemosphere (MPH) compounds (Perclot®, Baxter) in the treatment of severe hepatic hemorrhage in pig. METHODS Pigs were randomized to one of two equal treatment groups: MPH compounds (n=12) and Standard Packing (n=12). All animals underwent standardized surgical devascularization of the suprahepatic veins (grade V) to induce severe hepatic injury. Measures relating to the hemostatic success were monitored at 12, 60, 120 minutes and 24 hours post injury. RESULTS Animals allocated to treatment with MPH compounds were associated with higher survival rates at 24 hours than those undergoing standard packing: 66.7% vs, 0%, respectively (p=0.001). At 120 minutes MPH compounds were also associated with reduced blood loss, median (IQR) 1.16 (0.60) vs. 10.19 (5.77) mL/Kg, respectively: p<0.001) as well as higher invasive mean arterial pressures (iMAP) median (IQR) 39.12 (11.29) vs. 25.75 (14.28) mmHg, respectively: p=0.14) and hemoglobin levels median (IQR) 5.45 (2.50) vs. 6.45 (1.73) g/dL, respectively p=0.127). Overall, the application of MPH compounds required nearly half the time of standard packing median (IQR) 32.92 (6.51) vs. 67.75 (14.66) sec, respectively: p<0.001). CONCLUSIONS The data suggests that the use of MPH works in a severe hemorrhage in the liver of pigs, improving many variables in comparison to standard packing, including survival, blood loss and speed of application and we conclude that this offers a potential alternative for the treatment of hepatic injury. Further work is needed to corroborate these findings.
Collapse
Affiliation(s)
- Sánchez Del Valle Francisco José
- Central Hospital of Defense, General and Digestive Unit, Spanish Ministry of Defense, Spain.; University of Alcalá de Henares, Spain.
| | - De Nicolás Luis
- Central Hospital of Defense, General and Digestive Unit, Spanish Ministry of Defense, Spain
| | - Garófano Mota Juan
- Central Hospital of Defense, General and Digestive Unit, Spanish Ministry of Defense, Spain
| | - Del Pozo Antonio
- Central Hospital of Defense, Unit of Surgical Research, Spanish Ministry of Defense, Spain
| | | |
Collapse
|
5
|
Mecwan M, Li J, Falcone N, Ermis Sen M, Hassani A, Haghniaz R, Mandal K, Sharma S, Maity S, Zehtabi F, Zamanian B, Herculano R, Akbari M, John JV, Khademhosseini A. Recent advances in biopolymer-based hemostatic materials. Regen Biomater 2022; 9:rbac063. [PMID: 36196294 PMCID: PMC9522468 DOI: 10.1093/rb/rbac063] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 08/09/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Hemorrhage is the leading cause of trauma-related deaths, in hospital and pre-hospital settings. Hemostasis is a complex mechanism that involves a cascade of clotting factors and proteins that result in the formation of a strong clot. In certain surgical and emergency situations, hemostatic agents are needed to achieve faster blood coagulation to prevent the patient from experiencing a severe hemorrhagic shock. Therefore, it is critical to consider appropriate materials and designs for hemostatic agents. Many materials have been fabricated as hemostatic agents, including synthetic and naturally derived polymers. However, compared to synthetic polymers, natural polymers or biopolymers, which include polysaccharides and polypeptides, have greater biocompatibility, biodegradability, and processibility. Thus, in this review, we focus on biopolymer-based hemostatic agents of different forms, such as powder, particles, sponges, and hydrogels. Finally, we discuss biopolymer-based hemostats currently in clinical trials and offer insight into next-generation hemostats for clinical translation.
Collapse
Affiliation(s)
- Marvin Mecwan
- Terasaki Institute for Biomedical Innovation , Los Angeles, CA, 90064, USA
| | - Jinghang Li
- Terasaki Institute for Biomedical Innovation , Los Angeles, CA, 90064, USA
| | - Natashya Falcone
- Terasaki Institute for Biomedical Innovation , Los Angeles, CA, 90064, USA
| | - Menekse Ermis Sen
- Terasaki Institute for Biomedical Innovation , Los Angeles, CA, 90064, USA
| | - Alireza Hassani
- Terasaki Institute for Biomedical Innovation , Los Angeles, CA, 90064, USA
| | - Reihaneh Haghniaz
- Terasaki Institute for Biomedical Innovation , Los Angeles, CA, 90064, USA
| | - Kalpana Mandal
- Terasaki Institute for Biomedical Innovation , Los Angeles, CA, 90064, USA
| | - Saurabh Sharma
- Terasaki Institute for Biomedical Innovation , Los Angeles, CA, 90064, USA
| | - Surjendu Maity
- Terasaki Institute for Biomedical Innovation , Los Angeles, CA, 90064, USA
| | - Fatemeh Zehtabi
- Terasaki Institute for Biomedical Innovation , Los Angeles, CA, 90064, USA
| | - Behnam Zamanian
- Terasaki Institute for Biomedical Innovation , Los Angeles, CA, 90064, USA
| | - Rondinelli Herculano
- Terasaki Institute for Biomedical Innovation , Los Angeles, CA, 90064, USA
- São Paulo State University (UNESP), Bioengineering & Biomaterials Group, School of Pharmaceutical Sciences , Araraquara, SP, Brazil
- São Paulo State University (UNESP), Department of Biotechnology, School of Sciences , Humanities and Languages, Assis, SP, Brazil
| | - Mohsen Akbari
- Terasaki Institute for Biomedical Innovation , Los Angeles, CA, 90064, USA
- University of Victoria Department of Mechanical Engineering, , Victoria, British Columbia, Canada
- Biotechnology Center, Silesian University of Technology , Akademicka 2A, Gliwice, 44-100, Poland
| | - Johnson V John
- Terasaki Institute for Biomedical Innovation , Los Angeles, CA, 90064, USA
| | - Ali Khademhosseini
- Terasaki Institute for Biomedical Innovation , Los Angeles, CA, 90064, USA
| |
Collapse
|
6
|
Ramia JM, Aparicio-López D, Asencio-Pascual JM, Blanco-Fernández G, Cugat-Andorrá E, Gómez-Bravo MÁ, López-Ben S, Martín-Pérez E, Sabater L, Serradilla-Martín M. Applicability and reproducibility of the validated intraoperative bleeding severity scale (VIBe scale) in liver surgery: A multicenter study. Surgery 2022; 172:1141-1146. [PMID: 35871850 DOI: 10.1016/j.surg.2022.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/15/2022] [Accepted: 05/20/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Bleeding is an intraoperative and postoperative complication of liver surgery of concern, and yet evidence to support utility and reproducibility of bleeding scales for liver surgery is limited. We determined the reproducibility of the clinician-reported validated intraoperative bleeding severity scale and its clinical value of implementation in liver surgery. METHODS In this descriptive and observational multicenter study, we assessed the performance of liver surgeons instructed on the clinician-reported intraoperative bleeding severity scale using training videos that covered all 5 grades of bleeding severity. Surgeons were stratified according to years of surgical experience and number of surgeries performed per year based on a median split in low and high values. Intraobserver and interobserver agreement was assessed using Kendall's coefficient of concordance (Kendall's W). RESULTS Forty-seven surgeons from 10 hospitals in Spain participated in the study. The overall intraobserver concordance was 0.985, and the overall interobserver concordance was 0.929. For "high experience" surgeons, the intraobserver and interobserver agreement values were 0.990 and 0.941, respectively. For "low experience" surgeons, the intraobserver and interobserver agreement was 0.981 and 0.922, respectively. Regarding the annual number of surgeries, intraobserver and interobserver agreement values were 0.995 and 0.940, respectively, for surgeons performing >35 surgeries per year, with 0.979 and 0.923, respectively, for surgeons who perform ≤35 surgeries year. CONCLUSION The clinician-reported intraoperative bleeding severity scale shows high interobserver and intraobserver concordance, suggesting it is a useful tool for assessing severity of bleeding during liver surgery; years of surgical experience and number of annual procedures performed did not affect the applicability of the clinician-reported intraoperative bleeding severity scale.
Collapse
Affiliation(s)
- José Manuel Ramia
- Department of Surgery, Hospital General Universitario de Alicante, ISABIAL, Universidad Miguel Hernández, Alicante, Spain.
| | - Daniel Aparicio-López
- Department of Surgery, Hospital Universitario Miguel Servet, University of Zaragoza, Spain
| | | | | | - Esteban Cugat-Andorrá
- Department of Surgery, Hospital Universitari Germans Trias I Pujol, Barcelona, Spain; Department of Surgery, Hospital Mutua de Terrassa, Barcelona, Spain
| | | | | | - Elena Martín-Pérez
- Department of Surgery, Hospital Universitario La Princesa, Madrid, Spain
| | - Luis Sabater
- Department of Surgery, Hospital Clínico, University of Valencia, Biomedical Research Institute INCLIVA
| | - Mario Serradilla-Martín
- Department of Surgery, Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain
| |
Collapse
|
7
|
MacDonald MH, Zhang G, Tasse L, Wang D, De Leon H, Kocharian R. Hemostatic efficacy of two topical adjunctive hemostats in a porcine spleen biopsy punch model of moderate bleeding. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2021; 32:127. [PMID: 34591193 PMCID: PMC8484166 DOI: 10.1007/s10856-021-06586-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/12/2021] [Indexed: 05/19/2023]
Abstract
Topical hemostatic agents have become essential tools to aid in preventing excessive bleeding in surgical or emergency settings and to mitigate the associated risks of serious complications. In the present study, we compared the hemostatic efficacy of SURGIFLO® Hemostatic Matrix Kit with Thrombin (Surgiflo-flowable gelatin matrix plus human thrombin) to HEMOBLAST™ Bellows Hemostatic Agent (Hemoblast-a combination product consisting of collagen, chondroitin sulfate, and human thrombin). Surgiflo and Hemoblast were randomly tested in experimentally induced bleeding lesions on the spleens of four pigs. Primary endpoints included hemostatic efficacy measured by absolute time to hemostasis (TTH) within 5 min. Secondary endpoints included the number of product applications and the percent of product needed from each device to achieve hemostasis. Surgiflo demonstrated significantly higher hemostatic efficacy and lower TTH (p < 0.01) than Hemoblast. Surgiflo-treated lesion sites achieved hemostasis in 77.4% of cases following a single product application vs. 3.3% of Hemoblast-treated sites. On average, Surgiflo-treated sites required 63% less product applications than Hemoblast-treated sites (1.26 ± 0.0.51 vs. 3.37 ± 1.16). Surgiflo provided more effective and faster hemostasis than Hemoblast. Since both products contain thrombin to activate endogenous fibrinogen and accelerate clot formation, the superior hemostatic efficacy of Surgiflo in the porcine spleen punch biopsy model seems to be due to Surgiflo's property as a malleable barrier able to adjust to defect topography and to provide an environment for platelets to adhere and aggregate. Surgiflo combines a flowable gelatin matrix and a delivery system well-suited for precise application to bleeding sites where other methods of hemostasis may be impractical or ineffective.
Collapse
Affiliation(s)
- Melinda H MacDonald
- Ethicon, Inc., Johnson & Johnson, US Highway 22 West, Somerville, NJ, 08876-0151, USA
| | - Gary Zhang
- Ethicon, Inc., Johnson & Johnson, US Highway 22 West, Somerville, NJ, 08876-0151, USA
| | - Laura Tasse
- NAMSA, 6750 Wales Rd, Northwood, OH, 43619, USA
| | - Daidong Wang
- Cardiovascular and Specialty Solutions (CSS), Johnson & Johnson, 29A Technology Dr, Irvine, CA, 92618, USA
| | - Hector De Leon
- Scientific Consultant, 184 Bonita Hills Rd, Athens, GA, 30605, USA.
| | - Richard Kocharian
- Ethicon, Inc., Johnson & Johnson, US Highway 22 West, Somerville, NJ, 08876-0151, USA
| |
Collapse
|
8
|
Slezak P, Keibl C, Labahn D, Schmidbauer A, Genyk Y, Gulle H. A Comparative Efficacy Evaluation of Recombinant Topical Thrombin (RECOTHROM ®) With A Gelatin Sponge Carrier Versus Topical Oxidized Regenerated Cellulose (TABOTAMP ®/SURGICEL ®) In A Porcine Liver Bleeding Model. J INVEST SURG 2020; 34:862-868. [PMID: 31955627 DOI: 10.1080/08941939.2019.1705444] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE Topical hemostatic agents can be classified as active or passive. This study compared the hemostatic efficacy of an active agent, recombinant thrombin (RECOTHROM® [rT]) plus gelatin sponge carrier versus a passive agent, oxidized regenerated cellulose (TABOTAMP®/SURGICEL® [ORC]), in a porcine liver abrasion model. MATERIALS AND METHODS Eight pigs were used, four of them were heparinized. A total of 80 liver lesions were created, 40 of them in heparinized pigs. Lesions were treated with rT plus gelatin sponge or ORC. Bleeding rate was quantified before treatment by applying pre-weighed gauze. Time to hemostasis was assessed visually for 10 minutes. RESULTS Seven of the 80 lesions were excluded for having initial bleeding rates exceeding the target of 10 g/min. Sixteen and 20 lesions were treated with rT plus gelatin sponge and 19 and 18 lesions were treated with ORC, in non-heparinized and heparinized animals, respectively. Time to hemostasis (median [IQR]) was significantly shorter with rT plus gelatin sponge (30 [30,30] seconds) in heparinized and non-heparinized animals versus ORC in non-heparinized (180 [120,210] seconds) and heparinized animals (215 [135,345] seconds); P < 0.0001 for both comparisons. In heparinized animals, ORC took longer to achieve hemostasis, with treatment failure in 2/18 lesions. Time to hemostasis with ORC was longer for lesions in heparinized animals with initial bleeding rates of >5-10 g/min (285 [225,394] seconds) versus ≤5 g/min (175 [108,290] seconds). CONCLUSIONS In this model, rT plus gelatin sponge carrier (active) was a more effective hemostat than ORC (passive) in both heparinized and non-heparinized animals.
Collapse
Affiliation(s)
- Paul Slezak
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in the AUVA Trauma Research Center, Vienna, Austria
| | - Claudia Keibl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in the AUVA Trauma Research Center, Vienna, Austria
| | - Dirk Labahn
- Baxter Medical Products GmbH, Vienna, Austria
| | - Anna Schmidbauer
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in the AUVA Trauma Research Center, Vienna, Austria
| | - Yuri Genyk
- Division of Hepatobiliary, Pancreas, and Abdominal Organ Transplant, Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Heinz Gulle
- Baxter Medical Products GmbH, Vienna, Austria
| |
Collapse
|
9
|
Slezak P. Reply to Del Gaizo et al.'s "The SPOT GRADE: A Clinically Validated, Quantitative Bleeding Severity Scale". J INVEST SURG 2019; 34:558-560. [PMID: 31456446 DOI: 10.1080/08941939.2019.1651431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Paul Slezak
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in the AUVA Trauma Research Center, Vienna, Austria
| |
Collapse
|