Synthetic poly(vinyl alcohol)–chitosan as a new type of highly efficient hemostatic sponge with blood-triggered swelling and high biocompatibility

Rapid and effective hemostasis for a noncompressible hemorrhage is the key to control bleeding and reduce mortality. Chitosan (CS) has been widely used as a popular hemostatic dressing; however, irregularly shaped wounds present in emergencies limit the performance of CS powder. To improve the hemostatic effect of CS, we modified it with poly(vinyl alcohol) (PVA), a fast-swelling sponge triggered by water. The novel synthetic PVA-CS was prepared by cross-linking PVA and CS during foaming and crosslinking reactions. Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM) and X-ray diffraction were utilized to analyze the characteristics of PVA-CS. In vitro, the swelling ratio and blood clotting ability were evaluated in different groups with various weight ratios or degrees of deacetylation of the CS, and the cytocompatibility and cell attachment on the material were analyzed by human dermal fibroblast (HDF) cell testing. In vivo, the hemostatic effects were evaluated in Sprague-Dawley rats and Bama miniature pigs in a femoral artery hemorrhage model or gunshot wound experiment. PVA-CS presents robust mechanical strength, rapid water-triggered swelling and a fast absorption speed. As compared with gauze and PVA, which are widely used in first aid, PVA-CS sponges showed an improved blood clotting ability and increased blood cell and platelet adhesion and activation. The PVA-CS sponges also showed high biocompatibility in cell viability, cell proliferation and cell attachment bioassays. Furthermore, in vivo evaluation of the PVA-CS sponges revealed excellent hemostatic performance and enhanced wound healing with increased re-epithelialization and decreased granulation tissues. The results of this study strongly support the use of these composite sponges for noncompressible hemorrhage in acute trauma and ballistic injuries.