Use of a modified chitosan dressing in a hypothermic coagulopathic grade V liver injury model

BACKGROUND: Exsanguination from hepatic trauma is exacerbated by the lethal triad of acidosis, coagulopathy, and hypothermia. We evaluated the application of a modified chitosan dressing in a hypothermic coagulopathic model of grade V liver injury. METHODS: Subject swine underwent induced hypothermic coagulopathy followed by standardized grade V liver injuries. A modified chitosan dressing was applied and compared with standard packing. RESULTS: Pretreatment temperature, activated clotting time, and blood loss were similar between groups. Post treatment blood loss was significantly less and resuscitation mean arterial pressure were significantly greater in the modified chitosan group (P < .0001 and P < .018, respectively). Mean fluid resuscitative volume was significantly less in the modified chitosan group (P < .0056). Hemostasis was achieved on average 5.2 minutes following modified chitosan and never achieved with standard packing. At 1 hour post injury, all treatment animals survived compared with half of controls. CONCLUSIONS: Modified chitosan dressings provide simple rapid treatment of life-threatening liver injuries.