Proximal External Aortic Compression for Life-Threatening Abdominal-Pelvic and Junctional Hemorrhage: An Ultrasonographic Study in Adult Volunteers. (4th July 2019)

• Record Type: Journal Article
• Authors: Douma, Matthew J.; Picard, Christopher; O'Dochartaigh, Domhnall; Brindley, Peter G.
• Is Part Of: Prehospital emergency care. Volume 23:Number 4(2019)
• Page Start: 538
• Page End: 542
• Publication Date: 2019-07-04
• Subjects: trauma -- hemorrhage -- prehospital -- disaster -- austere settings; 362.18
• DOI: 10.1080/10903127.2018.1532477
• Languages: English
• ISSNs: 1090-3127

Abstract

Abstract: Introduction : Following life-threatening junctional trauma, the goal is to limit blood loss while expediting transfer to operative rescue. Unfortunately, life-threatening abdominal-pelvic or junctional hemorrhage is often not amenable to direct compression and few temporizing strategies are available beyond hemostatic dressings, hypotensive resuscitation, and balanced transfusion.Objectives : In this study, we evaluated proximal external aortic compression to arrest blood flow in healthy adult men.Methods : This was a simulation trial of proximal external aortic compression, for life-threatening abdominal-pelvic and junctional hemorrhage, in a convenience sample of healthy adult male volunteers. The primary end points were cessation of femoral blood flow as assessed by pulse wave Doppler ultrasound at the right femoral artery, caudal to the inguinal ligament. Secondary end points were discomfort and negative sequelae.Results : Aortic blood flow was arrested in 12 volunteers. Median time to blood flow cessation was 12.5 seconds. Median reported discomfort was 5 out of 10. No complications or negative sequelae were reported.Conclusion : This trial suggests that it may be reasonable to attempt temporization of major abdominal-pelvic and junctional hemorrhage using bimanual proximal external aortic compression. In the absence of immediate alternatives for this dangerous and vexing injury pattern, there appear to be few downsides to prehospital proximal external aortic compression while concomitantly expediting definite care.