Uncontrolled bleeding can prove fatal and no perfect hemostat has been discovered yet. According to the US National Trauma Institute, 35% of pre-hospital deaths, and more than 40% of deaths within the first 24 hours, are attributed to haemorrhage as further treatment and healing are not possible if bleeding is not controlled.
A substantial number of deaths can be prevented by quickly controlling bleeding. Management of bleeding has continuously evolved from cauterisation, tourniquets, and herbal remedies to clotting agents, bandages, and gauzes. Prolonged clotting time is the major limitation for these methods. In addition, an immune response may be triggered in some cases, limiting the healing process when conventional aids are used.
In 2015, the US Food and Drug Administration (FDA) granted approval for XSTAT, a single-use syringe containing numerous tiny cellulose sponges. XSTAT is said to stop bleeding within 20 seconds by creating pressure through the expansion of the sponges. These possess markers that aid in their removal before surgical repair. It was first approved in 2014 for military use.
Research is currently ongoing in this field to find different potential solutions to quickly control bleeding. In June 2017, the FDA granted approval to conduct clinical trials of ResQFoam, a self-expanding polyurethane that creates a rigid foam to seal a wound and stop bleeding. The material can easily be removed to perform surgery.
Nanotechnology can also provide transformational ways to manage bleeding. Although still in clinical trials, nano-based hemostatic device AC5 can potentially halt bleeding in laparoscopic and open surgical procedures. AC5 creates a nano-scale structure by self-assembling into the interstitial space of the connective tissue, forming a mechanical barrier. Similar research was performed at Rice’s BioScience Research Collaborative, where nano-based hydrogel is paired with snake venom (Batroxobin). Another innovation in this area is nano-bandages, which comprise alternate layers of thrombin and tannic acid.
Today, most of the hemostatic agents are only available for use in developed countries and no single antibleeding aid available is likely to be superior in every clinical condition. Therefore, there is a need to refine the already available compositions and discover novel, safer technologies that aid in hemostasis. In addition, antibleeding aids that can save lives in both combat situations and everyday emergencies should be made accessible globally.