Fibrin glue terminates massive bleeding after complex hepatic injury

Area of Science:

• Trauma surgery
• Surgical hemostasis
• Biomaterials in medicine

Background:

• Severe hepatic injuries often result in significant hemorrhage, posing a major challenge in trauma care.
• Current methods to control liver bleeding, such as packing, can be associated with complications.
• There is a need for effective topical hemostatic agents to manage complex liver injuries.

Purpose of the Study:

• To evaluate the efficacy of a packaged fibrin glue (FG) product in controlling severe bleeding from complex hepatic injuries.
• To assess FG's ability to reduce the need for surgical packing in a porcine model.

Main Methods:

• A porcine model of complex hepatic injury was developed, involving external blast and uncontrolled hemorrhage.
• Animals were randomized into two groups: control (routine surgical procedures) and fibrin glue (routine procedures plus FG application).
• Key endpoints included estimated blood loss (EBL), fluid resuscitation volume, and the need for surgical packing.

Main Results:

• Fibrin glue treated animals showed significantly lower EBL (300 mL vs. 875 mL) and required less fluid resuscitation (1.9 L vs. 2.9 L) compared to controls.
• None of the FG-treated pigs required surgical packing, whereas six of seven control pigs did.
• Mean arterial pressure and temperature changes were observed in both groups, with FG potentially mitigating some hemodynamic effects.

Conclusions:

• Packaged fibrin glue demonstrated significant efficacy in arresting severe hemorrhage from complex hepatic injuries in a porcine model.
• FG application eliminated the need for surgical packing in this model.
• Further clinical investigation is warranted to explore FG's benefits for hypotensive, coagulopathic trauma patients with visceral injuries.