Bioabsorbable Fibrillar Gauze Dressing Based on N-Carboxyethyl Chitosan Gelling Fibers for Fatal Hemorrhage Control

Abstract

Death from lethal hemorrhage remains a major problem in various emergency scenarios. There is a continuous interest in the development of absorbable hemostatic dressings that can control hemorrhage rapidly and can be left in the wound site without removal. In this study, we report a hemostatic gauze dressing based on N-carboxyethyl chitosan (CECS) gelling fibers. The CECS fibrillar gauze combines ultra-hydrophilic, cationic chemical property of the fiber components with the fluffy nonwoven material form, exhibiting good conformability for wound filling, high fluid uptaking capacity, and enhanced blood-concentrating effect. In a swine femoral artery injury model, the CECS fibrillar gauze achieves shorter time to hemostasis and less blood loss compared with commercially available hemostatic dressings. This chitosan gelling fiber gauze demonstrates comparable bioabsorbability to clinically used absorbable hemostat and thus may be applied to treat fatal hemorrhage both in emergency medical services and in internal surgical procedures.

Self-Oxidated Hydrophilic Chitosan Fibrous Mats for Fatal Hemorrhage Control

“…Specifically, the CECS-D group presented the shortest hemostasis time (156 ± 43 s) and the lowest blood loss (0.67 ± 0.37 g), which was ∼1/2 fold and ∼1/4 fold of that in the CECS group (328 ± 66 and 2.79 ± 0.81 s) and ∼1/3 fold and ∼1/6 fold of that in the gauze group (464 ± 59 s and 3.81 ± 0.59 g), respectively (Figure C,D). The above results suggest that CECS-D mats present superior hemostatic performance over CECS mats which have been reported to have the same hemostatic effect as commercialized Celox products in a swine femoral artery injury model . Although there was no obvious significant difference between the CECS-D group and CECS group, they showed a hemostasis time of 188 ± 67 and 296 ± 155 s and blood loss of 1.98 ± 0.52 and 3.42 ± 1.91 g for the CECS-D group and CECS group, respectively, which was far lower than that of the gauze group (968 ± 244 s, p < 0.001; 12.14 ± 5.34 g, p < 0.01), revealing high hemostatic efficacy of the CECS-D group and CECS group in rabbit spleen hemorrhage models (Figure E,F).…”

“…The above results suggest that CECS-D mats present superior hemostatic performance over CECS mats which have been reported to have the same hemostatic effect as commercialized Celox products in a swine femoral artery injury model. 35 Although there was no obvious significant difference between the CECS-D group and CECS group, they showed a hemostasis time of 188 ± 67 and 296 ± 155 s and blood loss of 1.98 ± 0.52 and 3.42 ± 1.91 g for the CECS-D group and CECS group, respectively, which was far lower than that of the gauze group (968 ± 244 s, p < 0.001; 12.14 ± 5.34 g, p < 0.01), revealing high hemostatic efficacy of the CECS-D group and CECS group in rabbit spleen hemorrhage models (Figure 4E,F). The above results indicated that CECS-D mats had excellent hemostatic capacity.…”

“…24 In our previous work, the intrinsic hemostasis efficiency of chitosan was integrated with superabsorbent capacity through hydrophilic carboxyethyl modification on chitosan fibers, which exerted a blood-concentrating effect on accelerating erythrocyte and platelet aggregation and thus achieved fast hemostasis. 35 Herein, to raise wet adhesiveness to provide a fast seal, and at the same time to promote coagulations of erythrocytes and platelets in the case of fatal hemorrhage, catechol-conjugated Ncarboxyethyl chitosan (CECS-D) fibrous mats were synthesized by grafting acrylic acid with 3,4-dihydroxybenzaldehyde on chitosan fibrous mats (Scheme 1). The mats are self-oxidated spontaneously under pH of blood to form quinone-amine adducts or quinone multimers, which could undergo an imine formation and/or Michael addition with fibrinogen involved in blood clotting and platelet adhesion, thus enhancing the anchor capacity of CECS-D mats to the platelet surface.…”

“…CECS fibrous mats were prepared according to our previous work. 35 In brief, 50 g of CS fibrous mats and 175 g of acrylic acid were added into 800 mL of ethanol and reacted at 60 °C for 48 h. After that, the mats were put in an ethanol solution containing 1 N aqueous NaOH to adjust the pH to 10−12. Finally, the mats were washed with ethanol aqueous solution (80%), followed by ethanol, and dried at 40 °C.…”

“…In our previous work, the intrinsic hemostasis efficiency of chitosan was integrated with superabsorbent capacity through hydrophilic carboxyethyl modification on chitosan fibers, which exerted a blood-concentrating effect on accelerating erythrocyte and platelet aggregation and thus achieved fast hemostasis . Herein, to raise wet adhesiveness to provide a fast seal, and at the same time to promote coagulations of erythrocytes and platelets in the case of fatal hemorrhage, catechol-conjugated N -carboxyethyl chitosan (CECS-D) fibrous mats were synthesized by grafting acrylic acid with 3,4-dihydroxybenzaldehyde on chitosan fibrous mats (Scheme ).…”