Effectiveness of use of local hemostatic agents for external bleeding by visiting ambulance teams

The alternative use of local hemostatic agents based on chitosan is the gentlest method of stopping bleeding, with minimal damaging effect on tissues, in comparison with the imposition of a hemostatic tourniquet or a pressure bandage.Goal. To evaluate the effectiveness of temporary stopping of external bleeding with the help of local hemostatic agents based on chitosan in powder and bandage forms and to determine the expediency of their use by visiting ambulance teams.Materials and methods. Specialists of the field teams of Ambulance and Medical Emergency Care Station n. a. A. S. Puchkov (Moscow, Russia) used local hemostatic agents based on chitosan in the form of a powder, a bandage in comparison with traditional hemostatic agents (a hemostatic tourniquet to stop arterial bleeding and a pressure bandage). The criteria for hemostasis were the absence of wetting of the pressure bandage and the absence of the need for a hemostatic tourniquet.Results. 103 patients were included in the main group, and 106 patients with arterial and venous bleeding from wounds of various localization were included in the control group. The age of patients in the compared groups ranged from 18 to 94 years. When using hemostatic powder and bandage, primary hemostasis was achieved in 99 patients in 96.1 % of cases, compared with the control group in 76 patients in 67.9 % of cases.Conclusions. Simplicity and ease of use, the speed of stopping bleeding and achieving results, as well as the absence of the need for special skills among specialists in the use of hemostatic agents, improved the quality of emergency medical care for patients with bleeding and allowed them to be recommended as a dressing for emergency medical care.

Hemostatic Efficacy and Safety of the Hemostatic Powder UI-EWD in Patients with Lower Gastrointestinal Bleeding

Background and Aims: Acute lower gastrointestinal bleeding (LGIB) is a common cause of emergency hospitalization and may require readmission for re-bleeding. Recently, a novel endoscopic hemostatic powder (UI-EWD/NexpowderTM, Nextbiomedical, Incheon, South Korea) was developed and applied for the control of LGIB. The aim of this study was to evaluate the hemostatic efficacy and long-term safety of UI-EWD in LGIB. Patients and Methods: We conducted a retrospective cohort study of LGIB at a single tertiary center in south korea. One hundred and sixty-seven consecutive patients with LGIB who were initially successful in endoscopic hemostasis were included and divided into the conventional treatment group (n = 112) and the UI-EWD therapy group (n = 55; 38 patients with conventional treatment and 17 patients with UI-EWD alone). The success rate of hemostasis, adverse events related to UI-EWD, and re-bleeding rate were evaluated. Results: The incidence of endoscopic hemostasis applied to the hepatic flexure (7.3% vs. 0%, p = 0.011) and larger than 4 cm (25.5% vs. 8.0%, p = 0.002) were significantly higher in the UI-EWD group than in the conventional therapy group. The cumulative rebleeding rate within 28 days in the UI-EWD group was 5.5% (3/55), which was significantly lower than that in the conventional treatment group (17.0% [19/112]; p = 0.039). No UI-EWD-related adverse events were recorded.Conclusion: Based on our results, application of UI-EWD in LGIB showed promising results for the prevention of re-bleeding, especially in locations where it is difficult to approach or cases with more bleeding. There were no significant complications, such as perforation or embolism. In particular, UI-EWD should be considered first for anatomical or technical impediments to endoscopic access in LGIB.

ISO 10993 Biological Evaluation of Novel Hemostatic Powder – 4SEAL®

Background:Hemostasis plays a crucial role during every surgery allowing for a bloodless operating field. Fast and effective surgery leads to a reduced risk of postoperative complications. One of the latest method for achieving homeostasis is the use of natural polysaccharide-based hemostatic powders. The study aimed to evaluate the biocompatibility according to the ISO 10993 standards of 4SEAL® Hemostatic powder.Methods:Chemical characterization (Headspace GC-MS, GC-MS, and ICP-MS), cytotoxicity, genotoxicity (MLA and AMES), endotoxin contamination, sensitization potential, intracutaneous reactivity, acute and subacute systemic toxicity with implantation, and pyrogenicity were evaluated to investigate the biocompatibility of the 4SEAL® Hemostatic powder. Studies were conducted according to ISO 10993 standards.Results:The biocompatibility requirements with accordance to ISO 10993-1 for 4SEAL® Hemostatic powder were met.Conclusions:4SEAL® Hemostatic powder is a promising new hemostatic agent with a wide range of potential applications and excellent biocompatibility.

Analysis on the healing of gastrointestinal ulceration by using Hemospray

Healing of gastrointestinal ulcers after Hemospray application was reported in literature. The pathophysiological mechanism of action of hemostatic powders is not elucidated so far. A prospective animal model was performed to evaluate the effect of Hemospray application on the healing process of artificially induced ulcers of the upper and lower gastrointestinal tract. In 10 pigs, 20 ulcers were created in each the upper and the lower gastrointestinal tract by endoscopic mucosal resection. 50% of the pigs were immediately treated with Hemospray application, the others were not treated. Ulcer size was measured endoscopically on day 0, 2, and 7. On day 7 the ulcers were histopathological evaluated for capillary ingrowth and the thickness of the collagen layer. After 7 days the sizes of the ulcers decreased significantly (stomach: − 22.8% with Hemospray application, − 19% without Hemospray application; rectum: − 50.8% with Hemospray application, − 49.5% without Hemospray application; p = 0.005–0.037), but without significant difference between both groups. This study shows no significant effect of the hemostatic powder Hemospray on ulcer healing in the upper and lower gastrointestinal tract compared with untreated controls, neither harmful nor beneficial. However, some trends merit further trials in patients and may indicate a possible mechanism of accelerated mucosal healing.