Rediscovering the wound hematoma as a site of hemostasis during major arterial hemorrhage

Summary Background Treatments for major internal bleeding after injury include permissive hypotension to decrease the rate of blood loss, intravenous infusion of plasma or clotting factors to improve clot formation, and rapid surgical hemostasis or arterial embolization to control bleeding vessels....

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Bibliographic Details
Published in:Journal of thrombosis and haemostasis 2015-12, Vol.13 (12), p.2202-2209
Main Authors: White, N. J., Mehic, E., Wang, X., Chien, D., Lim, E., St. John, A. E., Stern, S. A., Mourad, P. D., Rieger, M., Fries, D., Martinowitz, U.
Format: Article
Language:English
Subjects:
angiography
Animals
Axillary Artery - diagnostic imaging
Axillary Artery - drug effects
Axillary Artery - physiopathology
Blood Coagulation
Coagulants - administration & dosage
coagulopathy
Disease Models, Animal
Elasticity Imaging Techniques
Factor VIIa - administration & dosage
Feasibility Studies
Female
Femoral Artery - diagnostic imaging
Femoral Artery - physiopathology
Hematoma - blood
Hematoma - diagnosis
Hematoma - physiopathology
Hemodynamics
Hemophilia
Hemorrhage
Hemorrhage - blood
Hemorrhage - diagnosis
Hemorrhage - drug therapy
Hemorrhage - physiopathology
hemostasis
Hemostasis - drug effects
Sus scrofa
Time Factors
trauma
Ultrasonography, Doppler
ultrasound
Veins & arteries
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Summary:Summary Background Treatments for major internal bleeding after injury include permissive hypotension to decrease the rate of blood loss, intravenous infusion of plasma or clotting factors to improve clot formation, and rapid surgical hemostasis or arterial embolization to control bleeding vessels. Yet, little is known regarding major internal arterial hemostasis, or how these commonly used treatments might influence hemostasis. Objectives (i) To use a swine model of femoral artery bleeding to understand the perivascular hemostatic response to contained arterial hemorrhage. (ii) To directly confirm the association between hemodynamics and bleeding velocity. (iii) To observe the feasibility of delivering an activated clotting factor directly to internal sites of bleeding using a simplified angiographic approach. Methods Ultrasound was used to measure bleeding velocity and in vivo clot formation by elastography in a swine model of contained femoral artery bleeding with fluid resuscitation. A swine model of internal pelvic and axillary artery hemorrhage was also used to demonstrate the feasibility of local delivery of an activated clotting factor. Results In this model, clots formed slowly within the peri‐wound hematoma, but eventually contained the bleeding. Central hemodynamics correlated positively with bleeding velocity. Infusion of recombinant human activated factor VII into the injured artery near the site of major internal hemorrhage in the pelvis and axillae was feasible. Conclusions We rediscovered that clot formation within the peri‐wound hematoma is an integral component of hemostasis and a feasible target for the treatment of major internal bleeding using activated clotting factors delivered using a simplified angiographic approach.
ISSN:1538-7933
1538-7836
1538-7836
DOI:10.1111/jth.13158