Comparison of the efficacy of five standard topical hemostats: a study in porcine liver and spleen models of surgical bleeding

Table 1 Adapted version of the validated intraoperative bleeding scale. Adapted with permission from Lewis KM, et al. Surgery. 2017 [27]

Grade	Visual presentation	Anatomic Appearance	Qualitative description	Time to Hemostasis^a (min)	Rate of blood loss^b (mL/min)
4	No bleeding	No bleeding	No bleeding	≤ 2	≤ 1
3	Ooze or intermittent flow	Capillary-like bleeding	Mild	> 2–5	> 1–5
2	Continuous flow	Venule and arteriolar-like bleeding	Moderate	> 5–8	> 5–10
1	Controllable spurting and/or overwhelming flow	Non central venous and arterial-like bleeding	Severe	> 8–10	> 10–50
0	Unidentified or inaccessible spurting or gush	Central arterial- or venous-like bleeding	Life-threatening^c	> 10	> 50

^aParameter added to the original four items of the intraoperative bleeding scale, which was designed and validated for use in clinical studies to generate labelling claims [27]
^bVisual rate of blood loss (original item of the intraoperative bleeding scale) [27], unless hemostasis was not achieved 2 min after application of the hemostatic device, in which case the rate of blood loss was quantified using dry pre-weighted gauze to collect blood loss for 1 min
^cSystemic resuscitation required (e.g., volume expanders, vasopressors, or blood products)

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