FIBRIN GLUE TERMINATES MASSIVE BLEEDING AFTER COMPLEX HEPATIC-INJURY

Objective: We determined the ability of a packaged fibrin glue (FG) pr oduct to terminate severe bleeding in a new porcine model of complex h epatic injury. Methods: Femoral arterial and venous catheters were pla ced in pentobarbital-anesthetized swine (n = 7 per group, 16-18 kg), P igs received an external blast to the right upper abdomen at 0 minutes , followed by uncontrolled hemorrhage at 0 to 30 minutes, with anticoa gulation (heparin, 200 U/kg) at 10 minutes. Pigs were resuscitated wit h lactated Ringer's solution (20 mL/kg) beginning at 15 minutes and th en underwent laparotomy to control bleeding at 30 minutes. Lactated Ri nger's solution was infused to keep mean arterial pressure greater tha n 70 mm Hg until 120 minutes, when repeat laparotomy was performed. Co ntrol animals (group I) underwent routine surgical procedures to termi nate bleeding followed by packing if hepatic bleeding continued. The F G animals (group II) underwent routine surgical procedures plus applic ation of FG, Avoidance of packing, estimated blood loss (EBL) during a nd after laparotomy, and fluid resuscitation volume were the primary e nd points studied. Results: In both groups, mean arterial pressure var ied significantly from baseline to 120 minutes (group I: 100 +/- 3 to 52 +/- 11 mm Hg; group II: 99 +/- 4 to 66 rt 3 mm Hg). Temperature dec reased at the end of each experiment (group I: 37 +/- 1 to 33 +/- 1 de grees C; group II: 37 +/- 1 to 34 +/- 1 degrees C). There were no grou p differences in EEL before laparotomy (0-30 minutes), but from initia l laparotomy to repeat laparotomy (30-120 min), EEL (group I: 875 +/- 265 mL; group II: 300 +/- 59 mL) and total fluid resuscitation (group I: 2.9 +/- 0.4 L; group II: 1.9 +/- 0.3 L) were statistically signific antly less in PG pigs, Of greatest importance, six of seven control pi gs required packing, but none of the FG animals were parked and none b led at repeat laparotomy. Conclusion: FG stopped bleeding and eliminat ed the need for packing in a model of severe liver injury. Further wor k in the clinical arena is warranted to determine the potential benefi ts of FG in arresting hemorrhage in hypotensive, hypothermic, coagulop athic trauma patients with complex visceral injuries.