Section of Acute and Critical Care Surgery — Featured News

Foam addresses severe bleeding

Use of a specialized foam to stop severe internal bleeding due to trauma is a step closer to reality in the operating rooms of Barnes-Jewish Hospital and other Level 1 trauma centers, largely through the efforts of a Washington University trauma surgeon.

Grant Bochicchio, MD, MPH, the Harry Edison Professor of Surgery and chief of the Section of Acute and Critical Care Surgery, is principal investigator of a phase I clinical trial evaluating the safety of ClotFoam® in patients who experience mild-to-moderate bleeding during liver surgery. The foam — noncompressible and designed to stop bleeding — is administered via an applicator device during surgery.

Bochicchio and colleagues already have established the foam’s effectiveness in animals; their clinical trial evaluates safety and effectiveness in humans — the later stages of T1 translational research.

The National Institutes of Health (NIH) and U.S. Army have funded the research to investigate methods to stop hemorrhage in soldiers wounded on the battlefield. The need to address this problem is under-scored in a Wall Street Journal article, which reported the findings of a team of military medical specialists: Almost a quarter of Americans killed over 10 years in recent wars died on the battlefield of wounds they potentially could have survived with proper medical care; 90 percent bled to death when the bleeding could have been stopped.

“The only other product available to treat this type of bleeding is a pellet that expands in patients who are bleeding from tract wounds, such as from a gunshot,” says Bochicchio.

Bochicchio sees a broader application. For example, the foam could be used to control bleeding in victims of motor vehicle crashes and other trauma, for whom bleeding is the most preventable cause of death.

In other work, Bochicchio and the University of Maryland’s Marc Simard, MD, PhD, have investigated the use of the drug glyburide to prevent secondary brain injury in lab animals. Bochicchio recently completed a Department of Defense-funded trial demonstrating that glyburide was safe in healthy human subjects. He and colleagues plan future trials assessing its effectiveness as a prophylactic agent for individuals at risk for brain injury.

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Blood-clotting drug evaluated for trauma

Washington University researchers are preparing to study the use of tranexamic acid (TXA) to stop severe bleeding in trauma patients. Early trials of TXA — already used to control bleeding conditions such as hemophilia — have demonstrated benefits for trauma patients. The Washington University study, scheduled to start in fall or winter 2015, will dive deeper to examine TXA’s effects on immune function and coagulation, as well as dosing, efficacy and safety.

Section Chief Grant Bochicchio, MD, MPH, and pediatrician Philip Spinella, MD, director of the Critical Care Translational Research Program, will lead the Department of Defense-funded trial in trauma patients at Barnes-Jewish Hospital.

Many trauma patients experience coagulopathy — a condition in which the blood’s ability to clot is impaired — and die from sudden rapid blood loss. Standard care involves administering intravenous sterile saline en route to the hospital and evaluating possible use of blood products once there. The trial will include this standard treatment but will randomly assign patients to low-dose TXA, moderate-dose TXA or placebo.

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Highlights

• The American College of Surgeons (ACS) gave the Barnes-Jewish Hospital Trauma Program high marks during a site visit in which it re-verified the hospital as a Level 1 Trauma Center. ACS Level 1 verification is considered a gold standard for trauma centers. Reviewers found no deficiencies and praised the program for its involvement with the ACS and leadership on state and regional committees overseeing trauma care. The ACS first verified Barnes-Jewish as a Level 1 Trauma Center in 1996.
• Washington University physicians at Barnes-Jewish Hospital have played a key role in developing guidelines for Missouri’s Time-Critical Diagnosis statute, which designates certain hospitals as trauma, stroke and STEMI (ST-segment elevation myocardial infarction) centers. Douglas Schuerer, MD, director of trauma, and Julie Nash, MSN, RN, manager of trauma and acute care surgery, have led development of regulations that bring smaller hospitals into the trauma system as Level 4 centers so they can receive guidance in treating and transferring patients.
• Grant Bochicchio, MD, MPH, joined a coalition of top U.S. trauma surgeons who appeared before Congress to highlight the need for more trauma research funding. The coalition was assembled by major trauma organizations including the American Association for the Surgery of Trauma, the Eastern Association for the Surgery of Trauma and the Western Trauma Association.