Highlights from #EAST2014 - Biofoam for Abdominal Hemorrhage

Interesting concept, more applicable to prehospital or military situations.

SELF-EXPANDING POLYURETHANE FOAM IMPROVES SURVIVAL IN A LARGE ANIMAL MODEL OF EXSANGUINATION FROM ILIAC ARTERY TRANSECTION

David King, MD*, John O. Hwabejire, MD, MPH, Miroslav P. Peev, MD, Michael Duggan, DVM, George Velmahos, MD, PhD, MSEd, Marc A. deMoya, MD*, John Beagle, BS, Adam P. Rago, MS, John Marini, BS, Upma Sharma, PhD Massachusetts General Hospital

Presenter: David King, MD
Discussant: Joseph DuBose, MD, University of Texas-Houston

Objectives: We have previously demonstrated the effectiveness of a self-expanding poly(urea)urethane foam in reducing mortality from a lethal hepato-portal injury. The utility of this therapy in a noncompressible large arterial injury model remains unknown. We hypothesized that foam therapy would improve survival following iliac artery transection.

Methods: Swine underwent transection of the right intra-peritonealized external iliac artery in a closed abdominal cavity, resulting in rapid exsanguination. After injury, animals were randomized to either: control group (n=14), treatment group 1 (120mL foam dose, n=13), or treatment group 2 (100mL foam dose,
n=12). Animals were monitored for three hours. Main outcome measures included survival duration, overall percent survival, and hemorrhage rate.

Results: One hour after injury, survival was higher in group 1 than controls (85% vs. 14%, p<0.001) and in group 2 compared to controls (82% vs. 14%, p=0.001). Both foam treatment groups had significantly longer survival times compared to controls (group 1: 125±59 minutes, group 2: 130±63 minutes vs. controls: 42±37 minutes, all p<0.001). In group 1, the volume of blood loss (33±13 ml vs. 46±8 ml in controls, p=0.004) and the rate of hemorrhage (0.55±0.85 ml/minute vs. 3.19±4.36 ml/minute in controls, p=0.042) were reduced. Similarly, in group 2, the volume (35±15 ml vs. 46±8 ml in controls, p=0.03) and rate (0.50±0.59 ml/minute vs. 3.19±4.36 ml/minute in controls, p=0.045) of bleeding were reduced.

Conclusions: This study establishes efficacy of foam treatment in a large vessel, high pressure, arterial
injury. These findings, combined with our previous work, demonstrate the potential of foam to treat exsanguinating, noncompressible, venous, portal, and arterial injuries in the pre-hospital environment as a bridge to definitive surgical intervention.