When an injury causes severe internal

bleeding, patients need to get to the operating table quickly to survive. But in a war zone, where explosions and shrapnel can cause some of the most traumatic of these injuries, medical attention is often more than an hour away. Medical researchers have been tinkering with numerous solutions to try to keep more injured soldiers alive; now scientists at Arsenal Medical , a private company based in Watertown, Mass., are developing a foam compound designed to stop the bleeding until the patient can get into surgery.

The treatment for severe abdominal bleeding, which just received a DARPA Phase II contract for $15.5 million, consists of injecting two liquids into the belly button. Upma Sharma, head of the research team, describes the double-barreled syringe as working like an epoxy gun: When the liquids combine, they form a polyurethane foam that expands and hardens. As the foam conforms to the patient's internal organs and presses against them, it slows the bleeding. Once the patient is hospitalized, a surgeon can remove the foam and operate.

The team's first DARPA contract, which requested a biological material that could bind to injured tissue and stop bleeding, specifically asked that researchers not explore foam as an option. So many previous teams had worked with foam compounds already that the military had become skeptical of them, as no one had figured out how to use foam for internal wounds—in other attempts, pooling blood inside the abdomen pushed the foam out of the way.

Originally Sharma's team used foam only as a transport mechanism for the biological bonding system they hoped to develop, which would have delivered specialized ligands, or small molecules that bind to specific proteins, to the site of a wound to block blood loss. After running into the same obstacles as other foam-based solutions, and a little trial and error, they found the solution: Instead of making a compound that mixed with blood, they needed one that refused to mix with it. This repelling effect allowed the foam to push blood away, forcing it away from the wound. Once the researchers figured out how to get foam to the injured tissue, they saw their subjects' survival rates go up—even without any added biological material. When they showed DARPA the data, they got the green light to focus on the foam itself.

"We're really excited about the potential impact it can have on a really severe problem for the military," Sharma tells PM, "and it's been great to see everyone come together to support it."

The team is in the earliest stages of engaging with the FDA, which means human trials are far off. But animal trials have been promising so far. In pigs inflicted with liver trauma, survival rates rose from 10 percent to 100 percent for the first hour after injury when the scientists used the foam, and to 70 percent for 3 hours.

The main hurdle, Sharma admits, is removing the foam safely so surgery can commence. Cutting a patient from pelvis to sternum in order to remove a block of foam sounds pretty invasive, but Sharma points out that such an incision is already necessary to repair the kind of internal damage suffered by patients who need the foam. And it seems as if the foam has no long-term effects on the organs it compresses. In a second round of trials, pigs with lower trauma levels were treated with foam, which was then removed. Three weeks later they were examined and showed no negative effects.

"We got very excited when we had this compelling efficacy signal," she says, "but the next question is safety. You don't want to convert a quick death into a very slow death."

There are many steps to take before the product can be taken to the battlefield, but Sharma believes it could change the prognoses for soldiers, and someday even civilians, with traumatic internal injuries.

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