Hemorrhage is the leading cause of death in both military and civilian trauma. A recent study indicated that the leading cause of death in Canadian Forces members in Afghanistan is hemorrhage at 38% of total death, followed by neurologic injury at 33% and blast injuries at 16%. Significant advances in hemostatic biomaterials in the past decade have led to reduced mortality on the battlefield. In this presentation, I will first describe the requirements for an ideal hemostatic agent on the battlefield and then review the current biomaterials and hemostats for topical and intravenous applications for combat hemorrhage. I will then talk about some of my work on development of injectable hemostatic gels, and PEGylation of fibrinogen and pepticles for non-compressible bleeding which constitutes the leading cause of potentially preventable death on the battlefield. The hemostatic gels were composed of ploy(allylamine hydrochloride) (PAA) and multifunctional poly(ethylene glycol) (PEG) N-hydroxysuccinimide ester or oxidized dextran (Odex).Gelation time depends on the solution concentration of each polymer. The PEGylation was conducted with 4-arm poly(ethylene glycol) (PEG) with N-hydroxysuccinimide ester end groups under different conditions and characterized using FTIR, MALDI-MS, a bicinchoninic acid assay and a PEG assay. The hemostatic efficacies of these biomaterials were evaluated in vitro using thrombelastography and in vivo using animal bleeding models. Future research for hemorrhage control on the battlefield will be discussed as well.
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