Adjuncts for Tissue stasis

SUMMARY Despite advances in surgical tools and techniques and the development of rapid transport systems to highly specialized medical centers, mortality rates from exsanguination due to injuries sustained in military and civilian trauma have not improved appreciably in the last 150 years. Scientists and clinicians, motivated by the promise of new hemorrhage control adjuncts, have recently increased research and development in an effort to combat this problem. This review describes the epidemiology of hemorrhagic death in both the military and civilian populations, the research implications of these injury patterns, and some of the most promising products – whether already in use or under evaluation – for the control of bleeding. A survey of fibrinogen‐based products, recombinant factor VIIa, antifibrinolytic agents, products containing poly‐N‐acetyl glucosamine and other novel agents are presented. Preclinical and clinical data of products are outlined and the physical properties, mechanisms of action, and safety issues for each hemorrhage‐control agent are discussed.