Fibrin glue terminates massive bleeding after complex hepatic injury

Stephen M. Cohn, John H. Cross, Michael E. Ivy, Ara J. Feinstein, Michael A. Samotowka

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Objective: We determined the ability of a packaged fibrin glue (FG) product to terminate severe bleeding in a new porcine model of complex hepatic injury. Methods: Femoral arterial and venous catheters were placed in pentobarbital-anesthetized swine (n = 7 per group, 16-18 kg). Pigs received an external blast to the right upper abdomen at 0 minutes, followed by uncontrolled hemorrhage at 0 to 30 minutes, with anticoagulation (heparin, 200 U/kg) at 10 minutes. Pigs were resuscitated with lactated Ringer's solution (20 mL/kg) beginning at 15 minutes and then underwent laparotomy to control bleeding at 30 minutes. Lactated Ringer's solution was infused to keep mean arterial pressure greater than 70 mm Hg until 120 minutes, when repeat laparotomy was performed. Control animals (group I) underwent routine surgical procedures to terminate bleeding followed by packing if hepatic bleeding continued. The FG animals (group II) underwent routine surgical procedures plus application of FG. Avoidance of packing, estimated blood loss (EBL) during and after laparotomy, and fluid resuscitation volume were the primary end points studied. Results: In both groups, mean arterial pressure varied significantly from baseline to 120 minutes (group I: 100 ± 3 to 52 ± 11 mm Hg; group II: 99 ± 4 to 66 ± 3 mm Hg). Temperature decreased at the end of each experiment (group I: 37 ± 1 to 33 ± 1°C; group II: 37 ± 1 to 34 ± 1°C). There were no group differences in EBL before laparotomy (0-30 minutes), but from initial laparotomy to repeat laparotomy (30-120 min), EBL (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 significantly less in FG pigs. Of greatest importance, six of seven control pigs required packing, but none of the FG animals were packed and none bled at repeat laparotomy. Conclusion: FG stopped bleeding and eliminated the need for packing in a model of severe liver injury. Further work in the clinical arena is warranted to determine the potential benefits of FG in arresting hemorrhage in hypotensive, hypothermic, coagulopathic trauma patients with complex visceral injuries.

Original languageEnglish (US)
Pages (from-to)666-672
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume45
Issue number4
DOIs
StatePublished - Oct 1998
Externally publishedYes

Fingerprint

Fibrin Tissue Adhesive
Laparotomy
Hemorrhage
Swine
Liver
Wounds and Injuries
Resuscitation
Arterial Pressure
Pentobarbital
Blood Group Antigens
Thigh
Abdomen
Heparin
Catheters
Control Groups
Temperature

Keywords

  • Abbreviated laparotomy
  • Fibrin glue
  • Liver injury

ASJC Scopus subject areas

  • Surgery

Cite this

Fibrin glue terminates massive bleeding after complex hepatic injury. / Cohn, Stephen M.; Cross, John H.; Ivy, Michael E.; Feinstein, Ara J.; Samotowka, Michael A.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 45, No. 4, 10.1998, p. 666-672.

Research output: Contribution to journalArticle

Cohn, Stephen M. ; Cross, John H. ; Ivy, Michael E. ; Feinstein, Ara J. ; Samotowka, Michael A. / Fibrin glue terminates massive bleeding after complex hepatic injury. In: Journal of Trauma - Injury, Infection and Critical Care. 1998 ; Vol. 45, No. 4. pp. 666-672.
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AU - Cross, John H.

AU - Ivy, Michael E.

AU - Feinstein, Ara J.

AU - Samotowka, Michael A.

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N2 - Objective: We determined the ability of a packaged fibrin glue (FG) product to terminate severe bleeding in a new porcine model of complex hepatic injury. Methods: Femoral arterial and venous catheters were placed in pentobarbital-anesthetized swine (n = 7 per group, 16-18 kg). Pigs received an external blast to the right upper abdomen at 0 minutes, followed by uncontrolled hemorrhage at 0 to 30 minutes, with anticoagulation (heparin, 200 U/kg) at 10 minutes. Pigs were resuscitated with lactated Ringer's solution (20 mL/kg) beginning at 15 minutes and then underwent laparotomy to control bleeding at 30 minutes. Lactated Ringer's solution was infused to keep mean arterial pressure greater than 70 mm Hg until 120 minutes, when repeat laparotomy was performed. Control animals (group I) underwent routine surgical procedures to terminate bleeding followed by packing if hepatic bleeding continued. The FG animals (group II) underwent routine surgical procedures plus application of FG. Avoidance of packing, estimated blood loss (EBL) during and after laparotomy, and fluid resuscitation volume were the primary end points studied. Results: In both groups, mean arterial pressure varied significantly from baseline to 120 minutes (group I: 100 ± 3 to 52 ± 11 mm Hg; group II: 99 ± 4 to 66 ± 3 mm Hg). Temperature decreased at the end of each experiment (group I: 37 ± 1 to 33 ± 1°C; group II: 37 ± 1 to 34 ± 1°C). There were no group differences in EBL before laparotomy (0-30 minutes), but from initial laparotomy to repeat laparotomy (30-120 min), EBL (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 significantly less in FG pigs. Of greatest importance, six of seven control pigs required packing, but none of the FG animals were packed and none bled at repeat laparotomy. Conclusion: FG stopped bleeding and eliminated the need for packing in a model of severe liver injury. Further work in the clinical arena is warranted to determine the potential benefits of FG in arresting hemorrhage in hypotensive, hypothermic, coagulopathic trauma patients with complex visceral injuries.

AB - Objective: We determined the ability of a packaged fibrin glue (FG) product to terminate severe bleeding in a new porcine model of complex hepatic injury. Methods: Femoral arterial and venous catheters were placed in pentobarbital-anesthetized swine (n = 7 per group, 16-18 kg). Pigs received an external blast to the right upper abdomen at 0 minutes, followed by uncontrolled hemorrhage at 0 to 30 minutes, with anticoagulation (heparin, 200 U/kg) at 10 minutes. Pigs were resuscitated with lactated Ringer's solution (20 mL/kg) beginning at 15 minutes and then underwent laparotomy to control bleeding at 30 minutes. Lactated Ringer's solution was infused to keep mean arterial pressure greater than 70 mm Hg until 120 minutes, when repeat laparotomy was performed. Control animals (group I) underwent routine surgical procedures to terminate bleeding followed by packing if hepatic bleeding continued. The FG animals (group II) underwent routine surgical procedures plus application of FG. Avoidance of packing, estimated blood loss (EBL) during and after laparotomy, and fluid resuscitation volume were the primary end points studied. Results: In both groups, mean arterial pressure varied significantly from baseline to 120 minutes (group I: 100 ± 3 to 52 ± 11 mm Hg; group II: 99 ± 4 to 66 ± 3 mm Hg). Temperature decreased at the end of each experiment (group I: 37 ± 1 to 33 ± 1°C; group II: 37 ± 1 to 34 ± 1°C). There were no group differences in EBL before laparotomy (0-30 minutes), but from initial laparotomy to repeat laparotomy (30-120 min), EBL (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 significantly less in FG pigs. Of greatest importance, six of seven control pigs required packing, but none of the FG animals were packed and none bled at repeat laparotomy. Conclusion: FG stopped bleeding and eliminated the need for packing in a model of severe liver injury. Further work in the clinical arena is warranted to determine the potential benefits of FG in arresting hemorrhage in hypotensive, hypothermic, coagulopathic trauma patients with complex visceral injuries.

KW - Abbreviated laparotomy

KW - Fibrin glue

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