Dry fibrin sealant dressings reduce blood loss, resuscitation volume, and improve survival in hypothermic coagulopathic swine with grade V liver injuries

Objective: The majority of early trauma deaths are caused by uncontrolled h emorrhage, and are frequently complicated by hypothermic and dilutional coa gulopathies. Any hemorrhage-control technique that achieves rapid hemostasi s despite a coagulopathy should improve the outcome of these patients. We c onducted this study to determine whether dry fibrin sealant dressings (DFSD ) would stop bleeding from grade V liver injuries in swine that were hypoth ermic and coagulopathic. Methods: Nineteen swine weighing 39.7 kg (mean and 95% confidence interval, 36.3-43.1), underwent a 60% isovolemic, hypothermic exchange transfusion w ith 33 degrees C 6% hetastarch to produce a dilutional and hypothermic coag ulopathy. The animals then received a grade V liver injury and one of three treatments: DFSD, conventional liver packing with gauze sponges, or immuno globulin G (IgG) placebo sealant dressing (blinded control). All animals we re resuscitated with lactated Ringer's solution to their preinjury mean art erial pressure. Blood loss after treatment, mean arterial pressure, resusci tation volume, hematologic variables, and core temperature were monitored f or 1 hour. Results: At the time of injury, core temperature = 33.3 degrees C (95% conf idence interval, 33.2-33.4), hemoglobin concentration = 4.4 g/dL (4.2-4.6), platelet count = 132 x 10(5)/mu L, (93-171), prothrombin time = 21.6 secon ds (19.6-23.5), activated partial thromboplastin time = 25.2 seconds (range , 22.9-27.5 seconds), and fibrinogen = 83 mg/dL (range, 76-89 mg/dL) across treatments. The posttreatment blood loss in the DFSD group was 669 mt, (ra nge, 353-1,268 mt), which was lower (p < 0.01) than the means of 3,321 mt ( range, 1,891-5,831 mt) and 4,399 mt (range, 2,321-8,332 mt) observed in the packing and IgG groups, respectively. The resuscitation volume in DFSD was 2,145 mt (range 1,310-3,514 mt), which was lower (p < 0.05) than the means of 5,222 mt (range 3,381-8,067 mt) and 5,542 mt (range 3,384-9,077 mt) in the packing and IgG groups, respectively. One-hour survival in the DFSD gro up was 83%, whereas survival in the packing and IgG groups mere 0% (p < 0.0 5). Conclusion: In swine with a grade V liver injury complicated by a dilutiona l and hypothermic coagulopathy, DFSD provided simple, rapid hemorrhage cont rol, decreased fluid requirements, and improved survival.