Fibrin glue terminates massive bleeding after complex hepatic injury

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.