The antibacterial experiments displayed that the antimicrobial efficiency against S. Superhydrophobic or superhydrophilic hemostatic materials Based on surface properties, materials can be categorized as hydrophobic or hydrophilic, which can be differentiated by their water contact angles. Superhydrophobic and superhydrophilic surfaces are common in nature and can be achieved by biomimetic design. Superhydrophobic surfaces, for example, may be inspired by duck feathers or lotus leaves, which are natural superhydrophobic materials [ 86 , 87 ].
It has been found that the nanostructure of lotus leaves contributes to the high water contact angles on their surface [ 88 ]. On the other hand, superhydrophilicity was initially discovered in human tears because they can spread and form a membrane to prevent any damage to the eyes; fish scales provided a new inspiration for superhydrophilic surfaces [ 86 , 89 ].
The properties of superhydrophobicity and superhydrophilicity can also be used in hemostatic processes. Superhydrophobic surfaces may attract proteins and form a film on the wound to prevent further loss of blood [ 93 , 94 ]. Hydrophilic materials, on the other hand, can extract water from the blood to speed up the coagulation process [ 94 ].
Normally, the superhydrophobic material can be coated on the outside of the hydrophilic wound dressing to prevent blood loss. For instance, Cui et al. When the HBP comes in contact with liquid such blood or water , the hydrophobic backbone chains can self-aggregate rapidly and the hydrophilic groups can be exposed to water and adhere to different material surfaces under moist environments.
In vivo hemostatic experiments showed that the HBP adhesives have good hemostatic performance and can stop bleeding within 1. The superhydrophobic property of CNFs may alleviate blood loss and increase the bacteria reduction rate.
In a rat injury model, compared to cotton gauze, the CNF gauze could control bleeding in 3 minutes and due to its superhydrophobic property, the CNF gauze is easy to peel without any wound tearing or hemorrhage. Cotton gauze and paraffin were used to prepare a Janus fabric with superhydrophobic and superhydrophilic properties [ 94 ]. Cotton gauze has an inherent hydrophilic property, with one side coated with paraffin to endow hydrophobic properties.
Therefore, the 2 sides of the Janus fabric have different surface properties of superhydrophobicity and superhydrophilicity, respectively. Dowling et al. The hm-chitosan was attached to the wound in the pig femoral artery model and the wound was successfully clotted when the material was removed after 3 hours. Therefore, the potential for hm-chitosan to be used as a low-cost wound dressing with high hemostatic efficiency is encouraging.
Biomimetic hemostatic materials Biomimetic materials research has a long history and is developing rapidly. Biomimetic materials are inspired by nature and examples include butterfly wings, bones, spider silks and mussels [ 98 , 99 ]. Recently, biomimetic materials have been applied in various fields, such as tissue engineering [ , ], myocardial tissue [ ], actuator materials [ ], drug delivery [ ] and conductive film [ ].
Most hemostatic adhesives may lose their efficiency underwater or in a wet environment because water molecules can impair the inter-surface physical adhesive forces and may change chemical bonds [ ]. Wound dressings with high hemostatic efficiency in the wet medium should be developed to meet such demands. Some marine organisms, such as mussels, have been found to have a natural ability to attach to different surfaces under the sea to gain necessary resources, avoid predators and improve genetic levels [ ].
Therefore, mussel-inspired hemostatic materials have been fabricated. Mussel foot proteins contain 3,4-dihydroxyphenylalanine, which can interact with substrates via strong covalent and noncovalent bonds; thus, the mussels have a strong capacity to adhere to wet surfaces [ , ].
Liu et al. In addition, the material displayed a long-term antibacterial ability against E. Based on the adhesive mechanisms of mussels and the chitosan-based adhesives, chitosan-graft-polypeptides were polymerized by different initiators. The copolymers displayed high lap-shear adhesion strength, In a rat skin injury and bone fracture model, the copolymer exhibited good hemostatic efficacy and shortened the healing period 1 day on skin wounds and 20 days on bone fracture compared with the control group 14 days on skin wounds and 60 days on bone fracture [ ].
Gecko feet have thousands of setae fibril arrays that can increase the adhesive force between gecko feet and various surfaces; therefore, gecko-like morphologies have been studied and used for developing hemostatic materials [ ]. Mahdavi et al. Gecko-based PGSA has been coated with a layer of oxidized dextran to promote tissue adhesion. The adhesive ability of this substance improved in an in vitro pig intestine tissue model and an in vivo mice abdomen subfascial tissue model relative to the unpatterned PGSA polymer.
Superelasticity Superelasticity is used to describe an extraordinary capacity of materials in shape transformation [ ]. Common superelastic materials include polymeric C 60 [ ], semicrystalline polymers [ ], carbon nanofibers [ , ] and thermostable nanofibrous aerogels [ ]. Superelastic materials have been used in aerospace, soft robots and supercapacitors [ ].
Picture a and scanning electron microscopy image b of the graphene oxide-poly vinyl alcohol aerogels [ ] Copyright by American Chemical Society, Washington, USA. In battlefields, the limbs and joints of soldiers are the body parts most likely to receive penetrating and deep traumatic injuries [ , ] that are difficult to repair or heal in a short time and may cause disability or death [ ].
To deal with such trauma, an injectable hemostatic material with superelastic properties may match the shapes of uncompressed wounds and promote wound healing. Zhao et al. The cryogel can rapidly recover its original shape upon contact with water less than 1 second and blood Figure 9. In vitro blood clotting tests demonstrated that incorporating carbon nanotubes into QCSG can strengthen the blood clotting capacity and shorten the blood clotting index.
Fan et al. Because of the interlaced structure between nanofibers and nanosheets, the aerogel has high compressive strength maximum An in vitro hemostatic performance test indicated the aerogel has excellent absorption and adhesion abilities for red blood cells and platelets. Hydrogels can also be designed as a superelastic hemostatic materials because of their high hemostatic performance and biocompatibility.
The hydrogels have a self-healing ability and their gelation time is 86 seconds. In a mouse liver model, relative to the control group about mg of blood loss , the hydrogel effectively stopped bleeding and reduced blood loss only mg. Therefore, the hydrogels can serve as an effective hemostatic dressing.
Shape memory polymers SMPs have a shape recovery ability and can also serve as effective hemostatic materials for uncompressed wounds. Jang et al. The SMP foams have a low density 0. The degradation experiment showed that the ester-containing foams can be completely degraded at day Thus, the biodegradable capacity can help patients to avoid secondary surgery.
Due to their porous structure, the mechanical strength of SMP foams was increased. Biodegradable SMP foams with clinically relevant thermal properties and rapid expansion performance have exhibited promising potential as hemostatic materials. High porosity aerogel Aerogels have attracted numerous attentions because of its outstanding properties, such as ultralow density, wide surface area, high mechanical properties, high porosity and so forth [ — ].
Various materials have been used to prepare the aerogels, including silica [ ], polyurethane [ ], cellulose [ ] and carbon [ ]. The most common method for fabricating aerogels is direct freezing. In the freezing process, the microstructure of aerogels can be tuned by controlling external conditions like temperature. External forces can influence the microstructural growth of aerogels.
Transverse magnetic fields, electrical fields and ultrasonic waves can cause different microstructures, namely, lamellar walls and mineral bridges, lamellar walls with long alignment and alternating complex rings, respectively [ ].
Studies have demonstrated that aerogels have a high water absorption rate, fast shape recovery ability and high compressive mechanical strength [ ]. Therefore, aerogels have been broadly used in varied fields, such as energy applications [ ], drug delivery systems [ ], skeletal muscle regeneration [ ] and 3D printing [ ].
Due to their high porosity and broad surface area, aerogels can be used in the hemostatic process and may have a similar hemostatic mechanism to ORC, that is, absorbing water when in contact with blood, forming a barrier at the bleeding site and serving as a matrix for clot formation [ ].
Mellado et al. In vitro coagulant experiments showed that the GO-based aerogels started to coagulate from the beginning and that the aerogels with incorporated proanthocyanidins can completely coagulate the blood after seconds. In the control group, coagulation of the blood began at 60 seconds and the blood was not completely coagulated after seconds. Another composite aerogel was prepared from dialdehyde nanocellulose fibers and collagen [ ]. The study reported that the aerogels have desirable properties, such as a density of 0.
The average activity of L cells was Therefore, the nanocellulose fiber-based composite aerogels have a promising potential to act as hemostatic sponge materials and tissue engineering scaffolds. Polypeptide Peptides are compounds composed of 2 to 50 amino acids and peptide bonds. A polypeptide contains 10 to 50 amino acids.
Peptides can also be used in hemostatic materials. Although different hemostatic materials, such as chitosan, collagen, cellulose nanofibers and fibrin, have been developed and the commercial hemostatic products based on these materials can be found on the market Table 1 , their limitations also remain for clinical and emergency situations.
Therefore, materials containing self-assembled peptides become an effective and alternative method. Self-assembled peptides are a kind of peptide that can organize each component spontaneously into a structure with certain sequences without external intervention [ ].
Studies have demonstrated that self-assembling peptides can form nanofibers in solution to promote the coagulation process [ ]. A layer-by-layer process was used to prepare a peptide-coated wound dressing. In vitro blood clotting experiments showed that RADA 16—1 and hemostatic materials like gauze and gelatin sponge coated with RADA 16—1 both can form nanofiber plug in rabbit red blood cells Figure 11a, b, c, d, e. The porcine skin injury model indicated that peptide-coated gauze can stop bleeding within 2 minutes.
Furthermore, Song et al. The results showed that, compared with Gelfoam a commercial gelatin sponge , the blood loss in the RADA 16—1 group was reduced and less histological responses occurred. Kumar et al. The platelet adhesion experiment indicated that KOD adhere more platelets and form larger clots compared with control groups Figure 11f, g. The soluble P-selectin secretion experiments demonstrated that KOD can active platelets.
These properties are similar to those of natural collagen. Therefore, the self-assembled KOD have the potential to serve as wound dressings. Uncontrolled bleeding is a major cause of traumatic death. Hence, highly effective hemostats play an essential role in controlling hemorrhage and reducing the death rate in prehospital treatment. Commercial wound dressings, based on traditional hemostatic materials, including fibrin, collagen and zeolite, are available on the market.
However, there are several disadvantages of these products, such as risk of infection, low tissue adhesion and secondary damage. High-performance hemostatic materials are, therefore, in demand to overcome these problems. Extensive research and development has been conducted in high-performance wound dressings to enhance hemostatic efficiency and promote wound healing. More work is needed to solve existing problems. Cost-effective hemostatic materials are also in great demand.
Therefore, future studies of hemostatic materials may focus on the development of multifunctional and cost-effective hemostatic materials to meet different clinical requirements as described above. Hematology glossary [Internet]. Hemostatic strategies for traumatic and surgical bleeding. Google Scholar. Injectable antibacterial conductive nanocomposite cryogels with rapid shape recovery for noncompressible hemorrhage and wound healing. Nat Commun. Impact of hemorrhage on trauma outcome: an overview of epidemiology, clinical presentations, and therapeutic considerations.
J Trauma Acute Care Surg. Adv Mater. Design and development of polysaccharide hemostatic materials and their hemostatic mechanism. Biomater Sci. PLoS One. Ann Biomed Eng. Flechsenhar K. A novel gelatin sponge for accelerated hemostasis. Colloids surfaces B Biointerfaces. Antimicrobial electrospun nanofibers of cellulose acetate and polyester urethane composite for wound dressing.
Airflow-directed in situ electrospinning of a medical glue of cyanoacrylate for rapid hemostasis in liver resection. Tomizawa Y. Clinical benefits and risk analysis of topical hemostats: A review.
J Artif Organs. Surgical adhesives: Systematic review of the main types and development forecast. Prog Polym Sci [Internet] ; 37 8 : — Andrology-Open Access ; 04 02 : 2 — 5. Endoscopic hemostasis using covered metallic stent placement for uncontrolled post-endoscopic sphincterotomy bleeding. Hemostatic suturing technique for uterine bleeding during cesarean delivery.
Obstet Gynecol. Local correction of a transverse loop colostomy prolapse by means of a stapler device. Tech Coloproctol. Surgical materials: Current challenges and nano-enabled solutions. Nano Today [Internet] ; 9 5 : — Surg Innov. Shai A , Maibach HI. Comparison of a new fibrin sealant with standard topical hemostatic agents.
Arch Surg. Topical hemostatic agents in surgery: review and prospects. Rev Col Bras Cir ; 45 5 : e Pol J Vet Sci. Pre-hospital haemostatic dressings: A systematic review. Injury [Internet] ; 42 5 : — Ann Thorac Surg [Internet] ; 38 4 : — Comparative efficacy of topical hemostatic agents in a rat kidney model.
Am J Surg. Lal AV. Comparative evaluation of absorbable hemostats: advantages of fibrin-based sheets. Urol Clin North Am [Internet] ; 36 2 : — Synergy in thrombin-graphene sponge for improved hemostatic efficacy and facile utilization. Colloids Surfaces B Biointerfaces [Internet] ; : 27 — The long term immunological response of swine after two exposures to a salmon thrombin and fibrinogen hemostatic bandage. Biologicals [Internet] ; 38 6 : — Prockop DJ. Annu Rev Biochem.
Morgenstern L. Graphene-kaolin composite sponge for rapid and riskless hemostasis. Zeolite-based hemostat QuikClot releases calcium into blood and promotes blood coagulation in vitro. Acta Pharmacol Sin. Application of a granular mineral-based hemostatic agent QuikClot to reduce blood loss after grade V liver injury in swine. Enhanced pro-coagulant hemostatic agents based on nanometric zeolites.
Microporous Mesoporous Mater. Carbohydr Polym [Internet] ; August : — Cheng, W. Huang, H. Degradable and bioadhesive alginate-based composites: an effective hemostatic agent. ACS Biomater. Huang, Y. Degradable gelatin-based IPN cryogel hemostat for rapidly stopping deep noncompressible hemorrhage and simultaneously improving wound healing.
CAS Google Scholar. Chen, G. Bioinspired multifunctional hybrid hydrogel promotes wound healing. Google Scholar. Nandi, S. Ultrasound enhanced synthetic platelet therapy for augmented wound repair. Park, S. Time-sequential modulation in expression of growth factors from platelet-rich plasma PRP on the chondrocyte cultures. Roy, S. Platelet-rich fibrin matrix improves wound angiogenesis via inducing endothelial cell proliferation. Wound Repair. Du, X. Anti-infective and pro-coagulant chitosan-based hydrogel tissue adhesive for sutureless wound closure.
Biomacromolecules 21 , — Gao, L. A novel dual-adhesive and bioactive hydrogel activated by bioglass for wound healing. NPG Asia Mater. Lokhande, G. Nanoengineered injectable hydrogels for wound healing application. Acta Biomater. Frelinger, A. Platelet-rich plasma stimulated by pulse electric fields: platelet activation, procoagulant markers, growth factor release and cell proliferation. Platelets 27 , — Bano, I.
Chitosan: a potential biopolymer for wound management. Harkins, A. Chitosan-cellulose composite for wound dressing material. Part 2. Antimicrobial activity, blood absorption ability, and biocompatibility. B , — Ueno, H. Topical formulations and wound healing applications of chitosan.
Drug Deliv. Ebrahimi, M. Design and formulation of inorganic dispersed organogel for hemostasis. Sandri, G. Agren, M. Zhou, Y. Efficacy, safety, and physicochemical properties of a flowable hemostatic agent made from absorbable gelatin sponge via vacuum pressure steam sterilization.
A highly efficient, in situ wet-adhesive dextran derivative sponge for rapid hemostasis. Biomaterials , 23—37 Okamoto, S. Positive effect on bone fusion by the combination of platelet-rich plasma and a gelatin beta-tricalcium phosphate sponge: a study using a posterolateral fusion model of lumbar vertebrae in rats.
Tissue Eng. A 18 , — Zhao, X. Wang, L. Leonhardt, E. Absorbable hemostatic hydrogels comprising composites of sacrificial templates and honeycomb-like nanofibrous mats of chitosan. Bu, Y. Tetra-PEG based hydrogel sealants for in vivo visceral hemostasis.
Antibacterial anti-oxidant electroactive injectable hydrogel as self-healing wound dressing with hemostasis and adhesiveness for cutaneous wound healing. Biomaterials , 34—47 Pourshahrestani, S. Polymeric hydrogel systems as emerging biomaterial platforms to enable hemostasis and wound healing. Injectable dry cryogels with excellent blood-sucking expansion and blood clotting to cease hemorrhage for lethal deep-wounds, coagulopathy and tissue regeneration.
Li, Z. Superhydrophobic hemostatic nanofiber composites for fast clotting and minimal adhesion. Gao, H. Hoseinpour Najar, M. Preparation and in vivo evaluation of a novel gel-based wound dressing using arginine-alginate surface-modified chitosan nanofibers.
Liu, M. Electrospun nanofibers for wound healing. Manoukian, O. Sproul, E. Development of biomimetic antimicrobial platelet-like particles comprised of microgel nanogold composites. Platelet-like particles dynamically stiffen fibrin matrices and improve wound healing outcomes. Nica, O. Histological aspects of full-thickness skin grafts augmented with platelet-rich fibrin in rat model.
Li, N. Tannic acid cross-linked polysaccharide-based multifunctional hemostatic microparticles for the regulation of rapid wound healing. Biranje, S. Hemostasis and anti-necrotic activity of wound-healing dressing containing chitosan nanoparticles. Tong, Z. Drugs 15 , 91 PubMed Central Google Scholar. Yu, L. A tightly-bonded and flexible mesoporous zeolite-cotton hybrid hemostat. Zhu, J. Hyaluronic acid and polyethylene glycol hybrid hydrogel encapsulating nanogel with hemostasis and sustainable antibacterial property for wound healing.
Interfaces 10 , — Xu, Q. A hybrid injectable hydrogel from hyperbranched PEG macromer as a stem cell delivery and retention platform for diabetic wound healing. Golafshan, N. Nanohybrid hydrogels of laponite: PVA-alginate as a potential wound healing material. Enoch, S. Basic science of wound healing.
Surgery 26 , 31—37 Broughton, G. II, Janis, J. Wound healing: an overview. Velnar, T. The wound healing process: an overview of the cellular and molecular mechanisms.
Gurtner, G. Wound repair and regeneration. Nature , — Reinke, J. Baum, C. Normal cutaneous wound healing: clinical correlation with cellular and molecular events. Smyth, S. Platelet functions beyond hemostasis. Laurens, N. Fibrin structure and wound healing. Yang, S. Injectable antibacterial conductive nanocomposite cryogels with rapid shape recovery for noncompressible hemorrhage and wound healing.
Peng, Z. Adjustment of the antibacterial activity and biocompatibility of hydroxypropyltrimethyl ammonium chloride chitosan by varying the degree of substitution of quaternary ammonium. Wu, Z. Antibacterial and hemostatic thiol-modified chitosan-immobilized AgNPs composite sponges. Lu, D. Biomimetic chitosan-graft-polypeptides for improved adhesion in tissue and metal.
Chen, J. Synergistic enhancement of hemostatic performance of mesoporous silica by hydrocaffeic acid and chitosan. Biomaterials , 83—95 Jennings, J. Deng, Y. Novel fenugreek gum-cellulose composite hydrogel with wound healing synergism: facile preparation, characterization and wound healing activity evaluation.
Zheng, C. B 7 , — Xie, X. Functionalized biomimetic composite nanfibrous scaffolds with antibacterial and hemostatic efficacy for facilitating wound healing. Hamada, Y. Identification of collagen as a new fish allergen. Bioch 65 , — Pan, H. Non-stick hemostasis hydrogels as dressings with bacterial barrier activity for cutaneous wound healing. Preparation and characterization of breathable hemostatic hydrogel dressings and determination of their effects on full-thickness defects.
Polymers 9 , Wang, Z. Green gas-mediated cross-linking generates biomolecular hydrogels with enhanced strength and excellent hemostasis for wound healing. Lan, G. Ag improvement of platelet aggregation and rapid induction of hemostasis in chitosan dressing using silver nanoparticles. Cellulose 27 , — Kim, S. Effectiveness of hemostatic gelatin sponge as a packing material after septoplasty: a prospective, randomized, multicenter study.
Auris Nasus Larynx 45 , — Nishiguchi, A. Underwater-adhesive microparticle dressing composed of hydrophobically-modified Alaska pollock gelatin for gastrointestinal tract wound healing. Injectable antimicrobial conductive hydrogels for wound disinfection and infectious wound healing. Zhang, S.
Oxidized cellulose-based hemostatic materials. Wang, C. Bioinspired, injectable, quaternized hydroxyethyl cellulose composite hydrogel coordinated by mesocellular silica foam for rapid, noncompressible hemostasis and wound healing.
Interfaces 11 , — Mendes, B. Intrinsically bioactive cryogels based on platelet lysate nanocomposites for hemostasis applications. Peptide-functionalized amino acid-derived pseudoprotein-based hydrogel with hemorrhage control and antibacterial activity for wound healing. The biological degradation of cellulose. FEMS Microbiol. Preman, N. Bioresponsive supramolecular hydrogels for hemostasis, infection control and accelerated dermal wound healing.
And the Celox-A applicator and plunger delivery system helps the agent reach even deeper inside a penetrating wound. In addition, it can be spread over large areas of open surface wounds. Fibrin-Based Sealant Collaboration between the U. Army and the American Red Cross has produced a dry fibrin-sealant dressing that represents the next generation of hemostatic products.
The dressing contains human fibrinogen, human thrombin and calcium chloride freeze-dried onto a polyglactin-mesh backing. Conveniently, it can be used directly out of the packaging without any preparation. In animal models, it has been shown to control both venous and arterial bleeding with excellent efficacy. Sometimes tissue will need to be splayed open to place the dressing into a deeper portion.
If blood soaks through the first layer, a second layer of hemostatic can be placed. If the wound is deep, then abdominal battle dressings or gauze can be used on top of the hemostatic to give it bulk.
A pressure dressing, either a roller bandage or ACE wrap, is sometimes used to hold the dressing in place. Direct pressure from a provider should also be continued on top of the dressings.
If needed, other adjuncts, such as pressure point activation or placement of a tourniquet, should be considered. Document the type and number of hemostatic dressings in your run report, and be sure to tell the receiving physician and nursing staff that hemostatics were used.
Recommendations for EMS Agencies We recommend the adoption of hemostatic dressings in the standard protocols for hemorrhage control as an adjunct to elevation, direct pressure, pressure points and tourniquets. They should not be considered a replacement for these standard means of bleeding control. All of the products currently available on the market are for temporary external use only, which includes open soft-tissue wounds on the extremities and torso.
Take care to investigate and confirm that the most up-to-date formulations of products are used, especially the latest versions of the QuikClot dressing, to avoid complications that were inherent in earlier formulations.
The use of all hemostatic dressings should be monitored for complications and product failures, as new technologies will always reveal deficiencies when use is expanded. References 1. EMS Today. Interview: U. Fire Administrator Lori Moore-Merrell. Industry News.
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