Effect of dry fibrin sealant dressings versus gauze packing on blood loss in grade V liver injuries in resuscitated swine

Background: We conducted this study to determine whether the dry fibrin sea lant dressing (DFSD) would stop bleeding from a grade V liver injury and to evaluate the effects of leaving the absorbable DFSD in survival animals. Methods: Twenty-four swine (40 +/- 3.0 kg) received a uniform grade V liver injury and were randomized to one of four 1-hour treatment groups: (1) gau ze packing, (2) DFSD, (3) immunoglobulin G placebo dressing, and (4) no tre atment. All animals were resuscitated with lactated Ringer's solution. Tota l blood loss (TBL), mean arterial pressure, resuscitation volume, and labor atory data were monitored for I hour after injury. Four swine were treated with the DFSD after grade V injury and allowed to survive for 7 or 14 days. Results: The TBL was 1,104 +/- 264 mL (mean +/- SEM), 544 +/- 104 mL, 4,223 +/- 1,555 mL, and 6,026 +/- 1,020 mL for groups 1,2, 3, and 4 respectively . TBL in DFSD animals was less than that in animals treated with gauze pack ing (p = 0.06). Grade V injuries were uniform among the I-hour groups, and no evidence of intrahepatic abscess, unusual adhesions, or hepatic vein, ve na caval, or pulmonary thromboses were noted in the long-term survival anim als. Conclusion: In this model of grade V liver injury, blood loss with the DFSD was 51% of that observed with standard gauze packing (not statistically di fferent). Initial survival data revealed no complications attributable to t he fibrin dressing. DFSD may provide simple, rapid, and definitive hemorrha ge control in life-threatening liver injuries without the need for reoperat ion.