Catastrophic Hemorrhage Control

Hello Summarians!

Wounds to the arterial system are always challenging, but even more so in uncontrolled field conditions. It is one thing to deal with an anesthetized surgical patient with a bleeding issue, versus a trauma victim, where it is difficult to determine the actual source of the bleeding. That is why the TRAUMAGEL study is so interesting.

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Prognosis For Untreated Liver Masses In Dogs

This retrospective single-institution study evaluated prognosis and prognostic factors in 49 client-owned dogs with CT-characterized hepatic tumors that were managed conservatively and were deceased at the time of analysis. The median survival time from diagnosis was 337 days, with a wide range of 2 to 1308 days, indicating that some dogs can survive for many months to years without definitive treatment. Several clinical and clinicopathologic factors were associated with poorer outcomes. Dogs presenting with weight loss had significantly shorter survival times than those without weight loss, as did dogs presenting with abdominal effusion. The presence of multiple hepatic masses was also associated with a shorter survival time compared with a solitary mass. In addition, higher AST values and lower hematocrit measured within 30 days of CT imaging were significantly associated with decreased survival. In contrast, tumor volume normalized to body weight was not related to survival time. Overall, the findings indicate that systemic clinical signs, evidence of hepatic decompensation, and laboratory abnormalities are more informative for prognostication than tumor size alone in dogs undergoing conservative management for hepatic tumors. 

Bottom line — Conservative treatment can be an option.

FMT For Chronic GI Disease.

This prospective observational study evaluated fecal microbiota transplantation (FMT) as an adjunct therapy in 41 dogs with refractory chronic enteropathy. Dogs received two to three rectal FMT treatments and were followed for three months with repeated assessment of clinical disease activity using the canine inflammatory bowel disease activity index (CIBDAI) and fecal microbiota profiling via the dysbiosis index (DI). 

Overall, 29 of 41 dogs showed a positive clinical response to FMT, although in eight dogs the improvement lasted less than 30 days. Among responders, median CIBDAI decreased significantly from 5 at baseline to 2 within 28–35 days after treatment, and this improvement was sustained through approximately three months of follow-up. In contrast, non-responders had similar baseline CIBDAI scores but showed no meaningful improvement over time. Importantly, corticosteroid therapy could be reduced in 14 dogs following FMT, supporting a potential corticoid-sparing effect. 

Baseline fecal microbiota composition was associated with treatment outcome. Dogs with a durable clinical response had significantly lower dysbiosis index values at inclusion compared with non-responders and dogs with only short-lived responses, suggesting that less severe baseline dysbiosis may be associated with greater benefit from FMT. 

In summary, FMT appears to be an effective adjunctive treatment for a subset of dogs with refractory chronic enteropathy and may allow reduction of corticosteroid use. However, dogs with more severe dysbiosis at baseline may be less likely to experience sustained clinical improvement, highlighting the importance of microbiota status in predicting response to therapy. 

2025 ACVIM Forum Research Report Program. J Vet Intern Med. 2025 Nov-Dec;39(6):e70255. doi: 10.1111/jvim.70255. PMID: 41026112; PMCID: PMC12482516. 

Bottom line — Early results are encouraging.

Hemorrhage Control In Large Animals

Uncontrolled hemorrhage is a major cause of morbidity and mortality in both human and veterinary medicine, particularly in trauma and surgical settings where the body’s intrinsic hemostatic mechanisms may be overwhelmed. Large animals such as horses, cattle, and other ruminants are especially vulnerable to life-threatening hemorrhage from surgical injury, trauma, or vascular rupture, and effective field-deployable hemostatic options are limited. TRAUMAGEL and VETIGEL are polysaccharide-based hemostatic hydrogels designed to rapidly adhere to bleeding tissues, form a mechanical barrier, and support clot formation. While VETIGEL has been adopted in small animal practice, the efficacy of these products in large animals had not been established before this study. Using a calf model of severe, high-pressure carotid arterial hemorrhage, this study demonstrated that TRAUMAGEL applied according to manufacturer guidelines and combined with gauze and direct pressure significantly reduced both time to hemostasis and overall hemorrhage severity compared with pressure alone. All calves treated with TRAUMAGEL achieved hemostasis, with a markedly shorter median time than controls, and control animals had substantially higher odds of uncontrolled bleeding. These findings align with prior experimental hemorrhage models in other species and support the concept that adhesive hydrogels are particularly advantageous in irregular, high-flow, and wet wound environments where traditional dressings are less effective. Although the study had limitations, including lack of blinding and variability in coagulation status and wound size, the results suggest that TRAUMAGEL is a promising adjunct for emergency hemorrhage control in large animals when wounds are external, accessible, and amenable to compression. Further clinical studies in real-world veterinary settings are warranted to confirm its utility across different species, wound types, and emergency scenarios. 

Radcliffe, R. M., Eggert, H. E., Hayes, G. M., Okudaira, M., Scimeca, K., Brooks, M. B., M’Cloud, W., & Fubini, S. L. (2025). A hemostatic hydrogel has high efficacy for the treatment of hemorrhage in a large animal randomized controlled trial. Journal of the American Veterinary Medical Association https://doi.org/10.2460/javma.25.06.0424 

Bottom line — Exciting results. Needs to be in First Aid kits.

Just putting things in perspective …