Testing of modified zeolite hemostatic dressings in a large animal model of lethal groin injury

Naresh Ahuja, Todd A. Ostomel, Peter M Rhee, Galen D. Stucky, Richard Conran, Zheng Chen, Ghada A. Al-Mubarak, George Velmahos, Marc DeMoya, Hasan B. Alam

Research output: Contribution to journalArticle

71 Citations (Scopus)

Abstract

BACKGROUND: We have previously identified a granular zeolite hemostat (ZH) as an effective agent for control of severe bleeding, and it is currently being used by the US troops in the battlefield. ZH causes an exothermic reaction on application, which theoretically can be decreased by altering its chemical composition or changing its physical properties. However, the effect of these alterations on the hemostatic efficacy is unknown. We tested modified zeolites and a chitosan based dressing against controls in a swine model of battlefield injury. METHODS: A complex groin injury was created in 60 swine (40-55 kg). This included semi-transection of the proximal thigh (level of inguinal ligament), and complete division of the femoral artery and vein. After 3 minutes, the animals were assigned to (1) no dressing (ND), (2) standard dressing (SD), (3-5) SD + chemically modified ZHs, where calcium was substituted with sodium (Na), barium (Ba), or silver (Ag), respectively, (6) SD + physically modified ZH, where "beads" were packaged in a fabric bag, (7) SD + chitosan based dressing (CD). Resuscitation was started 15 minutes after application of dressing (500 mL of 6% hetastarch over 30 minutes). Survival for 180 minutes was the primary endpoint for this study. In addition, blood loss, wound temperatures, and histologic tissue damage were recorded. RESULTS: Mortality in the group that was treated with the application of bagged ZH was 10% versus 100% in the no dressing group and 50% in the SD group (p < 0.05 vs. ND and SD groups). The Na ZH group had a mortality rate of 43%, whereas application of Ba and Ag substituted zeolites, and CD were associated with a mortality rate of 25%. Ionic substitution of zeolite decreased the in vivo temperature peak by 5 to 10°C. No histologic evidence of tissue necrosis was noted in this experiment. CONCLUSIONS: The use of zeolite hemostat can control hemorrhage and dramatically reduce mortality from a lethal groin wound. Modifications of zeolite hemostat can decrease the exothermic reaction and attenuate tissue damage.

Original languageEnglish (US)
Pages (from-to)1312-1320
Number of pages9
JournalJournal of Trauma
Volume61
Issue number6
DOIs
StatePublished - Dec 2006
Externally publishedYes

Fingerprint

Zeolites
Groin
Hemostatics
Bandages
Animal Models
Wounds and Injuries
Chitosan
Mortality
Barium
Swine
Hydroxyethyl Starch Derivatives
Hemorrhage
Temperature
Femoral Vein
Femoral Artery
Thigh
Silver
Ligaments
Resuscitation

Keywords

  • Bandages
  • Battlefield injury
  • Chitosan
  • Extremity
  • Femoral vessels
  • Groin
  • Hemostatic dressing
  • Swine
  • Uncontrolled hemorrhage
  • Zeolite

ASJC Scopus subject areas

  • Surgery

Cite this

Testing of modified zeolite hemostatic dressings in a large animal model of lethal groin injury. / Ahuja, Naresh; Ostomel, Todd A.; Rhee, Peter M; Stucky, Galen D.; Conran, Richard; Chen, Zheng; Al-Mubarak, Ghada A.; Velmahos, George; DeMoya, Marc; Alam, Hasan B.

In: Journal of Trauma, Vol. 61, No. 6, 12.2006, p. 1312-1320.

Research output: Contribution to journalArticle

Ahuja, N, Ostomel, TA, Rhee, PM, Stucky, GD, Conran, R, Chen, Z, Al-Mubarak, GA, Velmahos, G, DeMoya, M & Alam, HB 2006, 'Testing of modified zeolite hemostatic dressings in a large animal model of lethal groin injury', Journal of Trauma, vol. 61, no. 6, pp. 1312-1320. https://doi.org/10.1097/01.ta.0000240597.42420.8f
Ahuja, Naresh ; Ostomel, Todd A. ; Rhee, Peter M ; Stucky, Galen D. ; Conran, Richard ; Chen, Zheng ; Al-Mubarak, Ghada A. ; Velmahos, George ; DeMoya, Marc ; Alam, Hasan B. / Testing of modified zeolite hemostatic dressings in a large animal model of lethal groin injury. In: Journal of Trauma. 2006 ; Vol. 61, No. 6. pp. 1312-1320.
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AU - Ostomel, Todd A.

AU - Rhee, Peter M

AU - Stucky, Galen D.

AU - Conran, Richard

AU - Chen, Zheng

AU - Al-Mubarak, Ghada A.

AU - Velmahos, George

AU - DeMoya, Marc

AU - Alam, Hasan B.

PY - 2006/12

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N2 - BACKGROUND: We have previously identified a granular zeolite hemostat (ZH) as an effective agent for control of severe bleeding, and it is currently being used by the US troops in the battlefield. ZH causes an exothermic reaction on application, which theoretically can be decreased by altering its chemical composition or changing its physical properties. However, the effect of these alterations on the hemostatic efficacy is unknown. We tested modified zeolites and a chitosan based dressing against controls in a swine model of battlefield injury. METHODS: A complex groin injury was created in 60 swine (40-55 kg). This included semi-transection of the proximal thigh (level of inguinal ligament), and complete division of the femoral artery and vein. After 3 minutes, the animals were assigned to (1) no dressing (ND), (2) standard dressing (SD), (3-5) SD + chemically modified ZHs, where calcium was substituted with sodium (Na), barium (Ba), or silver (Ag), respectively, (6) SD + physically modified ZH, where "beads" were packaged in a fabric bag, (7) SD + chitosan based dressing (CD). Resuscitation was started 15 minutes after application of dressing (500 mL of 6% hetastarch over 30 minutes). Survival for 180 minutes was the primary endpoint for this study. In addition, blood loss, wound temperatures, and histologic tissue damage were recorded. RESULTS: Mortality in the group that was treated with the application of bagged ZH was 10% versus 100% in the no dressing group and 50% in the SD group (p < 0.05 vs. ND and SD groups). The Na ZH group had a mortality rate of 43%, whereas application of Ba and Ag substituted zeolites, and CD were associated with a mortality rate of 25%. Ionic substitution of zeolite decreased the in vivo temperature peak by 5 to 10°C. No histologic evidence of tissue necrosis was noted in this experiment. CONCLUSIONS: The use of zeolite hemostat can control hemorrhage and dramatically reduce mortality from a lethal groin wound. Modifications of zeolite hemostat can decrease the exothermic reaction and attenuate tissue damage.

AB - BACKGROUND: We have previously identified a granular zeolite hemostat (ZH) as an effective agent for control of severe bleeding, and it is currently being used by the US troops in the battlefield. ZH causes an exothermic reaction on application, which theoretically can be decreased by altering its chemical composition or changing its physical properties. However, the effect of these alterations on the hemostatic efficacy is unknown. We tested modified zeolites and a chitosan based dressing against controls in a swine model of battlefield injury. METHODS: A complex groin injury was created in 60 swine (40-55 kg). This included semi-transection of the proximal thigh (level of inguinal ligament), and complete division of the femoral artery and vein. After 3 minutes, the animals were assigned to (1) no dressing (ND), (2) standard dressing (SD), (3-5) SD + chemically modified ZHs, where calcium was substituted with sodium (Na), barium (Ba), or silver (Ag), respectively, (6) SD + physically modified ZH, where "beads" were packaged in a fabric bag, (7) SD + chitosan based dressing (CD). Resuscitation was started 15 minutes after application of dressing (500 mL of 6% hetastarch over 30 minutes). Survival for 180 minutes was the primary endpoint for this study. In addition, blood loss, wound temperatures, and histologic tissue damage were recorded. RESULTS: Mortality in the group that was treated with the application of bagged ZH was 10% versus 100% in the no dressing group and 50% in the SD group (p < 0.05 vs. ND and SD groups). The Na ZH group had a mortality rate of 43%, whereas application of Ba and Ag substituted zeolites, and CD were associated with a mortality rate of 25%. Ionic substitution of zeolite decreased the in vivo temperature peak by 5 to 10°C. No histologic evidence of tissue necrosis was noted in this experiment. CONCLUSIONS: The use of zeolite hemostat can control hemorrhage and dramatically reduce mortality from a lethal groin wound. Modifications of zeolite hemostat can decrease the exothermic reaction and attenuate tissue damage.

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KW - Femoral vessels

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KW - Hemostatic dressing

KW - Swine

KW - Uncontrolled hemorrhage

KW - Zeolite

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