Abstract
Introduction: Penetrating abdominal injury is a major cause of death in trauma. It may cause hypovolemia leading to tissue hypoperfusion, direct organ damage and cytokine activation that cause inflammatory damage, all of which lead to death. Alginate is a natural anionic polysaccharide typically derived from brown algae. Sodium alginate hydrogel, a hemostatic agent, offers a platform for targeting both mechanical and biological injuries. The current study assessed the effect of a sodium alginate denoted VLVG (Very Low Viscosity (high) G alginate) following abdominal trauma in a swine model of penetrating abdominal injury. Methods: Seven anesthetized pigs were instrumented with catheters and abdominal trauma was introduced by laparoscopic hepatectomy. Ten minutes after the induction of hypovolemic shock, three animals were intra-abdominally administered with VLVG and four animals with saline (controls). During 8h of continuous monitoring, various hemodynamic and biochemical variables were measured and liver biopsies for histological evaluation were taken. In order to compare the study group to the control in a specific time a-parametric Mann-Whitney test was used, assessment of tendency during time Friedman's test for a-parametric variables was used. In order to compare the effect of the treatment (i.e. normal saline VS VLVG alginate) repeated measures ANOVA model was used, and the p value was calculated based on the Greenhouse-Geiser test. This research was approved by the Hebrew University of Jerusalem ethics Committee number: MD16148533. Results: VLVG-treated animals were more hemodynamically stable vs controls as reflected by their lower heart rate and higher blood pressure. They also had lower levels of liver enzymes and lactate and tissue damage. Conclusions: Our results in this pilot abdominal injury model show that VLVG might be a promising new agent. The superior hemostatic and biocompatibility efficiency along with its tissue preserving properties may turn VLVG in the future to a device that could be used in the pre-hospital setting to improve survival of abdominal trauma injuries.
Intrahepatic pseudoaneurysm following penetrating abdominal injury: Surgical and endovascular management of 2 complicated cases
