Advances in haemostatic sponges: Characteristics and the underlying mechanisms for rapid haemostasis

Abstract

In traumatized patients, the primary cause of mortality is uncontrollable continuous bleeding and unexpected intraoperative bleeding which is likely to increase the risk of complications and surgical failure. High expansion sponges are effective clinical practice for the treatment of wound bleeding (irregular/deep/narrow) that are caused by capillaries, veins and even arterioles as they possess a high liquid absorption ratio so can absorb blood platelets easily in comparison with traditional haemostasis treatments, which involve compression, ligation, or electrical coagulation etc. When in contact with blood, haemostatic sponges can cause platelet adhesion, aggregation, and thrombosis, preventing blood from flowing out from wounds, triggering the release of coagulation factors, causing the blood to form a stable polymerized fibre protein, forming blood clots, and achieving the goal of wound bleeding control. Haemostatic sponges are found in a variety of shapes and sizes. The aim of this review is to facilitate an overview of recent research around haemostatic sponge materials, products, and technology. This paper reviews the synthesis, properties, and characteristics of haemostatic sponges, together with the haemostasis mechanisms of haemostatic sponges (composite materials), such as chitosan, cellulose, gelatin, starch, graphene oxide, hyaluronic acid, alginate, polyethylene glycol, silk fibroin, synthetic polymers silver nanoparticles, zinc oxide nanoparticles, mesoporous silica nanoparticles, and silica nanoparticles. Also, this paper reviews commercial sponges and their properties. In addition to this, we discuss various in-vitro/in-vivo approaches for the evaluation of the effect of sponges on haemostasis.

Keywords: Characteristics; Haemostasis; Haemostatic sponge; Mechanism; Nanoparticles.

Graphical abstract

Fig. 1

Composite materials used to form haemostatic sponges and their mechanism of action.

Fig. 2

Haemostatic chitosan sponges. (1) Alkylated chitosan-diatom bio silica sponge. A). The schematic diagram representation of AC (Alkylated Chitosan) and AC-DB (Alkylated Chitosan-Diatom Bio silica sponges; B). The haemostatic process of AC-DB (Alkylated Chitosan-Diatom Bio silica) sponge (X [47]. (2) A schematic representation of the synthesis of OBC, OBC/CS, and OBC/COL/CS haemostatic sponges [55].(3) S-CS/TPM haemostasis (sponge containing tilapia peptides and chitosan) and its haemostatic evaluation are depicted schematically [46].

Fig. 3

Chitosan/gelatin/oxidized cellulose sponges studied in-vitro and in-vivo as absorbable haemostatic agents according to the schematic diagram [53].

Fig. 4

The schematic diagrammatic representation of starch-based macroporous sponges (KR-Sps) covalently labelled with the antimicrobial peptide KR12 via the highly efficient thiolene photo click (SH-PEG-HS; dithiol-functionalized poly (ethylene glycol), St-gel: Potato starch gel, KR-Sp: KR12 immobilized starch-based sponge) [57].

Fig. 5

The ACGS20 (N-alkylated chitosan/graphene oxide porous sponge with 20% ratio) haemostasis mechanism is depicted in a schematic diagram [45].

Fig. 6

Schematic Diagram of the preparation of (a) cationized dextran (poly (2-dimethyl amino)-ethyl methacrylate)-grafted dextran (Dex-PDM)) and (b) haemostatic sponges [5].

Fig. 7

Available commercial sponges on the market.

Fig. 8

Chitin/corn stalk/Ag NPs composite sponge. (a) Depiction of a schematic for the preparation of Ag NPs. (b) Illustration of a schematic preparation of a chitin/corn stalk/Ag NPs composite sponge and the antibacterial haemostatic process [68].

Fig. 9

Schematic diagram showing the haemostasis mechanism of PDA/SiNP. (a) Formation of clots at the site of vessel injury after applying PDA/SiNP. (b) The potential haemostasis mechanisms of PDA/SiNP [139].