Engineered intravenous therapies for trauma

Trauma leading to severe hemorrhage and shock on average kills patients within 3–6 h after injury. With average prehospital transport times reaching 1–6 h in low- to middle-income countries, stopping the bleeding and reversing hemorrhagic shock is vital. First-generation intravenous hemostats rely on traditional drug delivery platforms, such as self-assembling systems, fabricated nanoparticles, and soluble polymers due to their active targeting, biodistribution, and safety. We discuss some challenges in translating these therapies to patients, as very few have successfully made it through preclinical evaluation in large animals, and none have translated to the clinic. Finally, we discuss the physiology of hemorrhagic shock, highlight a new low-volume resuscitant (LVR) PEG-20k, and end with considerations for the rational design of LVRs.