New hemostatic device for grade IV–V liver injury in porcine model: a proof of concept

Abstract

BackgroundThe liver is the most injured organ following abdominal trauma. Uncontrolled bleeding remains the main cause of early liver injury-related death, with a mortality rate of 50–54% in the first 24 h after admission and with 80% of operative deaths. Packing and reoperation account for the increased survival in severe liver trauma, and they are recommended for severe liver injuries (grades IV–V).Perihepatic packing can lead to several potential complications. An excessive packing can cause complications due to abdominal compartment syndrome, while a soft packing may be ineffective, and thus, bleeding can continue inadvertently with the consequent hypovolemic shock and potentially death.MethodsWe designed a new vacuum-based device to perform perihepatic packing without the negative side-effects of the classic technique. We conducted a prospective pilot feasibility study in a porcine model. We compared the traditional perihepatic packing (PHP) (n = 2) with the new VacBagPack device (VBP) (n = 2).ResultsBoth pigs survived with the new device and showed an equivalent outcome to the one that survived in the traditional technique group. Blood tests were similar too. This suggests that VBP could be at least as effective as traditional PHP.ConclusionsWe establish a first step towards the development of a new packing device. A new study with a bigger sample size still in pigs will be conducted. Also, an industrial model of the device is currently in production.

Histopathological Effects of Algan Hemostatic Agent (AHA) in Liver Injury Model in Rats

“…It was also aimed that the liver hemorrhage that is checked about 48-72 hours after the placement of compresses has stopped, otherwise it has the potential to have quite complex results, but if excessive packaging is involved due to surgical experience, it may cause complications again. [23] In the other study comparing surgical hemostatic sponges in liver injuries by using the rat model, three different types of sponges were applied as gelatin, horse collagen and oxidized cellulose, and their hemostatic capacities were compared. [24] Fontes et al observed that the similar hemostatic effects in all groups however, the gelatin sponge showed more inflammation and adhesion to the structures adjacent to the procedure than other groups.…”

A polymer‐based systemic hemostat for managing uncontrolled bleeding

“…In a rat liver laceration model, intravenous injection of HAPPI results in a significant decrease in blood loss from 19.0 g/kg (in the saline group) to 14.9 g/kg ( p = 0.0070) with a mortality rate decrease from 50% to 12.5% within the 2‐h monitoring period after injury. This nonsurgical hemostasis strategy for fatal hepatic hemorrhage is of clinical significance, given that liver is one of the most frequently injured organs in abdominal trauma, 46,47 and uncontrolled hemorrhage is the key cause of liver injury‐related casualty with a mortality rate up to 80% 48,49 . In case of bleeding episodes from hemophilia A mice, compared to the saline group, HAPPI‐treated mice showed much slower bleeding and three‐fold less blood loss with the 20‐min monitoring period, presumably due to the enhanced primary hemostasis step.…”

Comparison of hemostatic efficacy of topical Ankaferd Blood Stopper on heparinized and nonheparinized rats in bleeding related to liver injury

“…Many methods have been tried to prevent liver parenchymal bleeding depending on the cause of the bleeding. Among these methods, there are also the use of hemostatic materials [12][13][14] . There are studies on hemostats in normal bleeding, but there was no study with hemostats on intraabdominal solid organ bleeding in heparinized patients.…”