A systematic review on the use of topical hemostats in trauma and emergency surgery

被引：103

作者：

Chiara, Osvaldo ^{[1
]}

Cimbanassi, Stefania ^{[2
]}

Bellanova, Giovanni ^{[3
]}

Chiarugi, Massimo ^{[4
]}

Mingoli, Andrea ^{[5
]}

Olivero, Giorgio ^{[6
]}

Ribaldi, Sergio ^{[7
]}

Tugnoli, Gregorio ^{[8
]}

Basilico, Silvia ^{[1
]}

Bindi, Francesca ^{[1
]}

Briani, Laura ^{[1
]}

Renzi, Federica ^{[1
]}

Chirletti, Piero ^{[9
]}

Di Grezia, Giuseppe ^{[10
]}

Martino, Antonio ^{[11
]}

Marzaioli, Rinaldo ^{[12
]}

Noschese, Giuseppe ^{[13
]}

Portolani, Nazario ^{[14
]}

Ruscelli, Paolo ^{[15
]}

Zago, Mauro ^{[16
]}

Sgardello, Sebastian ^{[1
]}

Stagnitti, Franco ^{[17
]}

Miniello, Stefano ^{[18
]}

机构：

[1] State Univ Milano, Niguarda Hosp Milano, Gen Surg Trauma Team, Piazza Benefattori Osped 3, I-20162 Milan, Italy

[2] Osped Niguarda Ca Granda, Gen Surg Trauma Team, Milan, Italy

[3] SS Annunziata Hosp, Gen Surg, Taranto, Italy

[4] State Univ Pisa, Cisanello Hosp, Emergency Surg Unit, Pisa, Italy

[5] Policlin Umberto I Rome, Emergency Surg Dept, Dept Surg, Trauma Surg Unit, Rome, Italy

[6] State Univ Torino, Dept Surg Sci, Turin, Italy

[7] Umberto I Hosp, Emergency Surg, Rome, Italy

[8] Maggiore Hosp, Trauma Surg, Bologna, Italy

[9] State Univ La Sapienza, Gen Surg & Pancreat Surg Unit, Rome, Italy

[10] Ladolfi Hosp, Emergency Surg, Avellino, Italy

[11] Cardarelli Hosp, Emergency Surg, Naples, Italy

[12] State Univ Bari, Dept Emergency & Transplant Surg, Bari, Italy

[13] ARON Cardarelli, Trauma Ctr, Naples, Italy

[14] State Univ Brescia, Dept Clin & Expt Sci, Bari, Italy

[15] Osped Riuniti, Dept Emergency Surg, Ancona, Italy

[16] Policlin S Pietro, Minimally Invas Surg Unit, Bergamo, Italy

[17] State Univ Rome La Sapienza Polo Pontino, Latina, Italy

[18] Univ Bari, Dept Surg, Bari, Italy

来源：

BMC SURGERY | 2018年 / 18卷

关键词：

Hemorrhage; Trauma; Emergency surgery; Hemostats; Fibrin adhesives; Sealants; Mechanical hemostats; Hemostatic dressings; Systematic review; OXIDIZED REGENERATED CELLULOSE; RANDOMIZED CLINICAL-TRIAL; SEALANT PATCH TACHOSIL; FREE FIBRIN SEALANT; HEMORRHAGE CONTROL; AMERICAN-COLLEGE; CASE SERIES; AIR LEAKS; EFFICACY; SAFETY;

D O I：

10.1186/s12893-018-0398-z

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Background: A wide variety of hemostats are available as adjunctive measures to improve hemostasis during surgical procedures if residual bleeding persists despite correct application of conventional methods for hemorrhage control. Some are considered active agents, since they contain fibrinogen and thrombin and actively participate at the end of the coagulation cascade to form a fibrin clot, whereas others to be effective require an intact coagulation system. The aim of this study is to provide an evidence-based approach to correctly select the available agents to help physicians to use the most appropriate hemostat according to the clinical setting, surgical problem and patient's coagulation status. Methods: The literature from 2000 to 2016 was systematically screened according to PRISMA [Preferred Reporting Items for Systematic Reviews and Meta-Analyses] protocol. Sixty-six articles were reviewed by a panel of experts to assign grade of recommendation (GoR) and level of evidence (LoE) using the GRADE [Grading of Recommendations Assessment, Development and Evaluation] system, and a national meeting was held. Results: Fibrin adhesives, in liquid form (fibrin glues) or with stiff collagen fleece (fibrin patch) are effective in the presence of spontaneous or drug-induced coagulation disorders. Mechanical hemostats should be preferred in patients who have an intact coagulation system. Sealants are effective, irrespective of patient's coagulation status, to improve control of residual oozing. Hemostatic dressings represent a valuable option in case of external hemorrhage at junctional sites or when tourniquets are impractical or ineffective. Conclusions: Local hemostatic agents are dissimilar products with different indications. A knowledge of the properties of each single agent should be in the armamentarium of acute care surgeons in order to select the appropriate product in different clinical conditions.

引用

页数：20