Hydrophobically modified chitosan gauze: a novel topical hemostat

Apurva Chaturvedi, Matthew B. Dowling, John P. Gustin, Thomas M. Scalea, Srinivasa R. Raghavan, Jason D. Pasley, Mayur Narayan

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background Currently, the standard of care for treating severe hemorrhage in a military setting is Combat Gauze (CG). Previous work has shown that hydrophobically modified chitosan (hm-C) has significant hemostatic capability relative to its native chitosan counterpart. This work aims to evaluate gauze coated in hm-C relative to CG as well as ChitoGauze (ChG) in a lethal in vivo hemorrhage model. Methods Twelve Yorkshire swine were randomized to receive either hm-C gauze (n = 4), ChG (n = 4), or CG (n = 4). A standard hemorrhage model was used in which animals underwent a splenectomy before a 6-mm punch arterial puncture of the femoral artery. Thirty seconds of free bleeding was allowed before dressings were applied and compressed for 3 min. Baseline mean arterial pressure was preserved via fluid resuscitation. Experiments were conducted for 3 h after which any surviving animal was euthanized. Results hm-C gauze was found to be at least equivalent to both CG and ChG in terms of overall survival (100% versus 75%), number of dressing used (6 versus 7), and duration of hemostasis (3 h versus 2.25 h). Total post-treatment blood loss was lower in the hm-C gauze treatment group (4.7 mL/kg) when compared to CG (13.4 mL/kg) and ChG (12.1 mL/kg) groups. Conclusions hm-C gauze outperformed both CG and ChG in a lethal hemorrhage model but without statistical significance for key endpoints. Future comparison of hm-C gauze to CG and ChG will be performed on a hypothermic, coagulopathic model that should allow for outcome significance to be differentiated under small treatment groups.

Original languageEnglish (US)
Pages (from-to)45-52
Number of pages8
JournalJournal of Surgical Research
Volume207
DOIs
StatePublished - Jan 1 2017

Fingerprint

Chitosan
Hemorrhage
Bandages
Statistical Models
Splenectomy
Hemostatics
Femoral Artery
Standard of Care
Hemostasis
Punctures
Resuscitation
Arterial Pressure
Swine
Therapeutics

Keywords

  • Hemostasis
  • Hemostatic gauze
  • Hm-chitosan
  • Modified chitosan gauze
  • Trauma

ASJC Scopus subject areas

  • Surgery

Cite this

Chaturvedi, A., Dowling, M. B., Gustin, J. P., Scalea, T. M., Raghavan, S. R., Pasley, J. D., & Narayan, M. (2017). Hydrophobically modified chitosan gauze: a novel topical hemostat. Journal of Surgical Research, 207, 45-52. https://doi.org/10.1016/j.jss.2016.04.052

Hydrophobically modified chitosan gauze : a novel topical hemostat. / Chaturvedi, Apurva; Dowling, Matthew B.; Gustin, John P.; Scalea, Thomas M.; Raghavan, Srinivasa R.; Pasley, Jason D.; Narayan, Mayur.

In: Journal of Surgical Research, Vol. 207, 01.01.2017, p. 45-52.

Research output: Contribution to journalArticle

Chaturvedi, A, Dowling, MB, Gustin, JP, Scalea, TM, Raghavan, SR, Pasley, JD & Narayan, M 2017, 'Hydrophobically modified chitosan gauze: a novel topical hemostat', Journal of Surgical Research, vol. 207, pp. 45-52. https://doi.org/10.1016/j.jss.2016.04.052
Chaturvedi A, Dowling MB, Gustin JP, Scalea TM, Raghavan SR, Pasley JD et al. Hydrophobically modified chitosan gauze: a novel topical hemostat. Journal of Surgical Research. 2017 Jan 1;207:45-52. https://doi.org/10.1016/j.jss.2016.04.052
Chaturvedi, Apurva ; Dowling, Matthew B. ; Gustin, John P. ; Scalea, Thomas M. ; Raghavan, Srinivasa R. ; Pasley, Jason D. ; Narayan, Mayur. / Hydrophobically modified chitosan gauze : a novel topical hemostat. In: Journal of Surgical Research. 2017 ; Vol. 207. pp. 45-52.
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abstract = "Background Currently, the standard of care for treating severe hemorrhage in a military setting is Combat Gauze (CG). Previous work has shown that hydrophobically modified chitosan (hm-C) has significant hemostatic capability relative to its native chitosan counterpart. This work aims to evaluate gauze coated in hm-C relative to CG as well as ChitoGauze (ChG) in a lethal in vivo hemorrhage model. Methods Twelve Yorkshire swine were randomized to receive either hm-C gauze (n = 4), ChG (n = 4), or CG (n = 4). A standard hemorrhage model was used in which animals underwent a splenectomy before a 6-mm punch arterial puncture of the femoral artery. Thirty seconds of free bleeding was allowed before dressings were applied and compressed for 3 min. Baseline mean arterial pressure was preserved via fluid resuscitation. Experiments were conducted for 3 h after which any surviving animal was euthanized. Results hm-C gauze was found to be at least equivalent to both CG and ChG in terms of overall survival (100{\%} versus 75{\%}), number of dressing used (6 versus 7), and duration of hemostasis (3 h versus 2.25 h). Total post-treatment blood loss was lower in the hm-C gauze treatment group (4.7 mL/kg) when compared to CG (13.4 mL/kg) and ChG (12.1 mL/kg) groups. Conclusions hm-C gauze outperformed both CG and ChG in a lethal hemorrhage model but without statistical significance for key endpoints. Future comparison of hm-C gauze to CG and ChG will be performed on a hypothermic, coagulopathic model that should allow for outcome significance to be differentiated under small treatment groups.",
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N2 - Background Currently, the standard of care for treating severe hemorrhage in a military setting is Combat Gauze (CG). Previous work has shown that hydrophobically modified chitosan (hm-C) has significant hemostatic capability relative to its native chitosan counterpart. This work aims to evaluate gauze coated in hm-C relative to CG as well as ChitoGauze (ChG) in a lethal in vivo hemorrhage model. Methods Twelve Yorkshire swine were randomized to receive either hm-C gauze (n = 4), ChG (n = 4), or CG (n = 4). A standard hemorrhage model was used in which animals underwent a splenectomy before a 6-mm punch arterial puncture of the femoral artery. Thirty seconds of free bleeding was allowed before dressings were applied and compressed for 3 min. Baseline mean arterial pressure was preserved via fluid resuscitation. Experiments were conducted for 3 h after which any surviving animal was euthanized. Results hm-C gauze was found to be at least equivalent to both CG and ChG in terms of overall survival (100% versus 75%), number of dressing used (6 versus 7), and duration of hemostasis (3 h versus 2.25 h). Total post-treatment blood loss was lower in the hm-C gauze treatment group (4.7 mL/kg) when compared to CG (13.4 mL/kg) and ChG (12.1 mL/kg) groups. Conclusions hm-C gauze outperformed both CG and ChG in a lethal hemorrhage model but without statistical significance for key endpoints. Future comparison of hm-C gauze to CG and ChG will be performed on a hypothermic, coagulopathic model that should allow for outcome significance to be differentiated under small treatment groups.

AB - Background Currently, the standard of care for treating severe hemorrhage in a military setting is Combat Gauze (CG). Previous work has shown that hydrophobically modified chitosan (hm-C) has significant hemostatic capability relative to its native chitosan counterpart. This work aims to evaluate gauze coated in hm-C relative to CG as well as ChitoGauze (ChG) in a lethal in vivo hemorrhage model. Methods Twelve Yorkshire swine were randomized to receive either hm-C gauze (n = 4), ChG (n = 4), or CG (n = 4). A standard hemorrhage model was used in which animals underwent a splenectomy before a 6-mm punch arterial puncture of the femoral artery. Thirty seconds of free bleeding was allowed before dressings were applied and compressed for 3 min. Baseline mean arterial pressure was preserved via fluid resuscitation. Experiments were conducted for 3 h after which any surviving animal was euthanized. Results hm-C gauze was found to be at least equivalent to both CG and ChG in terms of overall survival (100% versus 75%), number of dressing used (6 versus 7), and duration of hemostasis (3 h versus 2.25 h). Total post-treatment blood loss was lower in the hm-C gauze treatment group (4.7 mL/kg) when compared to CG (13.4 mL/kg) and ChG (12.1 mL/kg) groups. Conclusions hm-C gauze outperformed both CG and ChG in a lethal hemorrhage model but without statistical significance for key endpoints. Future comparison of hm-C gauze to CG and ChG will be performed on a hypothermic, coagulopathic model that should allow for outcome significance to be differentiated under small treatment groups.

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KW - Trauma

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