# Arterial Junctional Hemostasis without Compression: Evaluation of Visco-liquid Hemostats in Male Swine✰

## TL;DR

A new gel-based treatment stops arterial bleeding in pigs without needing pressure, offering a potential solution for hard-to-treat wounds.

## Contribution

Trimethylpentyl polysilsesquioxane (POSS) gels with kaolin or chitin achieve hemostasis without compression in arterial trauma.

## Key findings

- POSS-Kaolin significantly reduced blood loss compared to QuikClot gauze.
- POSS-Chitin also reduced blood loss but less effectively than POSS-Kaolin.
- POSS gels maintained systemic blood pressure better than QuikClot.

## Abstract

•Traumatic non-compressible hemorrhage causes considerable preventable deaths.•No current effective treatment for non-compressible wounds with brisk venous or arterial blood flow.•Trimethylpentyl polysilsesquioxane viscogels (POSS) yielded hemostasis without compression.•POSS can be efficacious in treating non-compressible trauma wounds.

Traumatic non-compressible hemorrhage causes considerable preventable deaths.

No current effective treatment for non-compressible wounds with brisk venous or arterial blood flow.

Trimethylpentyl polysilsesquioxane viscogels (POSS) yielded hemostasis without compression.

POSS can be efficacious in treating non-compressible trauma wounds.

Trimethylpentyl polysilsesquioxane (POSS) gels containing kaolin and chitin promote clotting and stabilize and strengthen thrombi in vitro, and may offer a potential solution for treating non-compressible wounds. This study was designed to determine if the gels could stop bleeding in a junctional arterial hemorrhage model. Anesthetized male swine were instrumented for systemic arterial pressure (MAP) measurement and saline infusion. A femoral artery was punctured (2 × 6 mm), allowed to bleed freely for 45 s, and then either QuikClot gauze bandage (QC; n = 7), POSS-Kaolin (PK) or POSS-Chitin (PC) (40 ml; n = 7/group) applied with no external compression. Blood loss (BL) at 60 min post-treatment was greater in QC (1166±79 ml) than PK (188±74 ml; p < 0.0001) or PC (523±116 ml; p = 0.0001); BL in PC was greater than in PK (p = 0.03). Total BL (180 min) was higher in QC (1210±93 ml) than PK (475±85 ml, p < 0.001) or PC (632±133 ml; p = 0.002) and in PC vs PK (p = 0.008). Time to clot was not different between PK (3 ± 1) or PC (10±3 min), but was longer in QC (44±9 min) than PK or PC (p < 0.0001 vs PK, p < 0.0003 vs PC). MAP fell 40±3 mmHg in QC by 10 min post-injury (p < 0.0003), and remained below control. PC MAP fell 41±5 mmHg, but returned to control, and MAP did not change in PK. POSS in combination with kaolin or chitin provided hemorrhage control and systemic hemodynamic stability without compression. These results support the treatment concept that this new approach to hemostasis can be efficacious in treating non-compressible trauma wounds.

Image, graphical abstract