Ultra-fast self-gelling self-expanding self-propelling high-adhesion procoagulant hemostatic powder for non-compressible hemorrhage hemostasis in pigs

Non-compressible hemorrhage remains the chief cause of battlefield mortality and civilian trauma death. Here, we propose a hemostatic strategy based on ultrafast self-gelling self-expanding powder of polyacrylic acid (PAA), polyethyleneimine (PEI) and foaming agent, which achieves non-compressible hemorrhage hemostasis through the multiple synergistic effects of expansion plugging, self-gelling adhesion and activating the coagulation factors. The hemostatic powder integrates rapid physical crosslinking with spontaneous gas foaming, exhibits a fast gelation rate, high expansion ratio, strong tissue adhesion, and activation of red blood cells, platelets, and fibrin. The optimized formulation (PP/PT5-TXA30) achieves superior hemostatic performance compared to commercial powders in rat liver volumetric defect, femoral artery and vein transection, as well as complete transection of the subclavian artery and vein in rabbits. Notably, in a lethal porcine model of complete subclavian artery and vein transection, PP/PT5-TXA30 achieves superior performance of non-compressible hemorrhage compared to gauze and XStat™. Additionally, PP/PT5-TXA30 accelerates full-thickness skin wound healing. This work demonstrates a strategy based on ultra-fast self-gelling and self-expanding mechanisms for developing hemostatic materials for non-compressible hemorrhage.