A review of treatments for non-compressible torso hemorrhage (NCTH) and internal bleeding

Abstract

Non-compressible torso hemorrhage (NCTH) is associated with significant mortality in preventable deaths, both in the field and in civilian settings. Current management strategies of these injuries include fluid resuscitation, the use of foaming materials to occlude damaged vessels, and fibrin sealants. Researchers in the field have proposed multiple alternatives to these treatments, such as hemostatic sponges, self-assembling peptide materials, in situ crosslinking hydrogels, and intravenous nanoparticles, which are then challenged in a wide variety of injury models to evaluate their efficacy. This review first discusses the treatment of NCTH in the clinic and field before providing an overview of materials in literature designed for this same purpose, with the intention of summarizing the treatment options and research currently available in this field. The mechanisms of these hemostats, as well as their effectiveness in promoting hemostasis (evaluated through survival, bleeding time, and blood loss volume) are summarized side-by-side for easy comparison across various studies and animal models. Ultimately, a better understanding of existing technologies and the metrics through which they are evaluated may facilitate the development of safer, more effective therapies for non-compressible torso hemorrhage and internal bleeding.

Keywords: Hemostasis; Injury models; Internal bleeding; Materials; Non-compressible torso hemorrhage; Trauma.