Page 66 - Journal of Special Operations Medicine - Winter 2015

Evaluating Alternatives to
Traditional Cotton Laparotomy Sponges for Blood Absorption
in the Austere and Mobile Surgical Environment

Max R. Sirkin, MD; Patrick Cook, DO; Kurt G. Davis, MD

ABSTRACT

Background: The operative control of noncompressible Keywords: hemorrhage; laparotomy; cotton; rayon; sponge;
hemorrhage is the single largest impact that could be austere; surgery; packing; combat casualty care; absorption;
addressed in reducing the mortality on the battlefield. density
Laparotomy pads, traditionally used for hemorrhage
evacuation, are made of woven cotton, and, while ef-
fective, their use requires a substantial amount of space Introduction
and adds weight. This poses no concern in traditional
operating rooms but is a hindrance for mobile provid- The operative control of noncompressible hemorrhage
ers and providers in austere environments. We sought is the single largest factor that could be addressed in re-
to compare different absorptive compounds to ascer- ducing mortality on the battlefield. There is a demon-
tain their utility as alternatives for traditional lapa- strated improvement in survival the sooner the combat
rotomy pads. Methods: Samples of cotton laparotomy injured patient undergoes surgical evaluation and treat-
pads, pure rayon sheets, rayon–polypropylene compos- ment. In an attempt to impact these patients, equipment
1
ite sheets, and nylon–polyester composite “microfiber” and personnel are situated closer to the point of injury
sheets were weighed and submerged in heparinized in both combat and in austere medical environments.
whole bovine blood. After saturation, the fabrics were This movement of resources forward requires mobility.
weighed, wrung dry, reweighed, and resubmerged. This Two factors that limit this mobility are the space and the
process was performed for a total of three sequential weight of the necessary equipment. Both of these factors
submersions. The saturated weights and dry weights play a critical role in what providers can bring with them
of each fabric were used to calculate how much blood and, therefore, what is available to the injured patient.
each fabric could absorb initially and after multiple
repeated uses. The initial densities of the four fabrics Medical providers in austere, remote, or hostile envi-
was calculated and compared. Results: The initial sub- ronments must carefully assess the equipment they bring
mersions demonstrated that 1g each of cotton, rayon, and each item must demonstrate that it is a vital tool in
rayon–polypropylene, and nylon–polyester were able to the mission to come. Items that can serve dual purposes
absorb 7.58g, 12.98g, 10.16g, and 9.73g of blood, re- should be chosen; if an item can be reused, it is more
spectively. The second and third sequential trials, which beneficial than one that cannot.
were statistically similar, demonstrated that 1g of cot-
ton, rayon, rayon–polypropylene, and nylon–polyester Hemorrhage remains the most common preventable
were able to absorb 1.73g, 2.83g, 2.3g, and 2.3g of cause of death in all austere, hostile, or mobile theaters.
2
blood, respectively. The calculated densities of cotton, Tourniquets and packing material are the two mainstays
rayon, rayon–polypropylene, and nylon–polyester were of treating hemorrhage in the field. Tourniquets are very
0.087g/cm , 0.12g/cm , 0.098g/cm , and 0.093g/cm , effective for extremity hemorrhage, while packing mate-
3
3
3
3
respectively. Conclusion: Per gram, rayon absorbed rial is used for large soft-tissue or cavity injuries that are
approximately 1.7 times more blood than cotton and not amenable to tourniquet placement. For cavity inju-
used three-quarters the amount of the storage space. ries, hemostasis relies on a combination of direct pressure
Rayon also retained its superior absorption abilities and the patient’s coagulation properties. It is these injuries
on repeated uses, demonstrating the potential for re- that could be impacted by earlier surgical intervention.
use in remote and austere environments. Thus, rayon
could serve as a viable alternative to traditional cot- The primary tool used for surgical hemorrhage evacua-
ton laparotomy pads in the austere forward surgical tion is the laparotomy pad. It is impossible for the sur-
environment. geon to visualize and attempt to repair an injury until

54