mRDH Bandage for Surgery and Trauma: Data Summary and Comparative Review

Alginate-based composite microspheres coated by berberine simultaneously improve hemostatic and antibacterial efficacy

It is important to develop effective, biocompatible, easily stored and affordable hemostats for controlling bleeding and preventing infection in prehospital trauma. In this study, we synthesized a series of alginate-based composite microspheres coated by different amounts of berberine (SCC-1B, SCC-5B and SCC-10B), which were further characterized using scanning electron microscopy (SEM), viscometer, particle analyzer and Fourier transform infrared (FT-IR) spectroscopy. The in vitro and vivo results demonstrated that compared to control group (SCC, Composite polysaccharide microspheres without berberine, and CMPHP, Commercial hemostatic agent), SCC-10B with proper content berberine (7%), not only exhibited inherent excellent antibacterial activity, but also enhanced hemostatic effect by increasing adhesion and aggregation of blood cells, which could be considered as synergistic effects. More importantly, through inserting berberine into the cross-linked network, biodegradability and biocompatibility of SCC-10B were also improved. Taken together, SCC-10B could be a candidate for emergency hemostatic and antibacterial treatment in prehospital trauma.

In vitro and in vivo evaluation of the duck's feet collagen sponge for hemostatic applications

Recently different hemostatic agents have been developed, but most of them are ineffective in severe bleeding and expensive or cause safety concerns. In this study, we fabricated duck's feet collagen-based porous sponges and investigated its use as a hemostatic agent. We determined the sponge's physical and biological characteristics and compared with Avitene via scanning electron microscope analysis, water-uptake abilities and porosity test, and cytotoxicity assay. The duck's feet collagen/silk sponge showed a larger interconnected porous structure compared to others sponges. The duck's feet collagen/silk sponge also exhibited significantly higher porosity than Avitene. Hemostatic properties of the sponges were evaluated by whole blood clotting and rat femoral artery hemorrhage experiment. The addition of silk to duck's feet collagen showed better blood clotting ability than Avitene in vitro. However, rat femoral artery hemorrhage test showed a similar hemostatic property between the duck's feet collagen-based sponges and Avitene. We suggest that duck's feet collagen-based sponge can be effectively used for hemostatic applications.

Overview of Agents Used for Emergency Hemostasis

CONTEXT

In today's modern world, despite the multiple advances made in the field of medicine, hemorrhagic shock is still the main cause of battlefield mortality and the second most prevalent cause of mortality in civilian trauma. Hemostatic agents can play a key role in establishing hemostasis in prehospital situations and preventing hemorrhage-associated death. In this respect, this article aims to review different aspects of known hemostatic agents.

EVIDENCE ACQUISITION

A comprehensive search of the academic scientific databases for relevant keywords was conducted; relevant articles were compiled and assessed.

RESULTS

Hemostatic agents can establish hemostasis by means of different mechanisms, including concentrating coagulation factors, adhesion to the tissues, in which traumatic hemorrhage occurred, and delivering procoagulant factors to the hemorrhage site. Presently, these hemostatics have been significantly improved with regard to efficacy and in adverse consequences, resulting from their use. Several hemostatic dressings have been developed to the degree that they have received FDA approval and are being used practically on the battlefield. In addition, there are currently several case reports on the use of such hemostatics in the hospital setting, in conditions where commonly known approaches fail to stop life-threatening bleeding.

CONCLUSIONS

The use of hemostatic dressings and agents is one of the main advancements achieved in recent decades. However, it can be claimed that the ideal hemostatic has not been recognized yet; therefore, this topic needs to be brought into focus and further addressed.

Topical hemostatic agents and dressings in the prehospital setting

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.