First Case Report of SAM(r) Junctional Tourniquet Use in Afghanistan to Control Inguinal Hemorrhage on the Battlefield

Klotz, Jeffrey K.; Leo, Maura; Andersen, Brent L; Nkodo, Adrien A; Garcia, Gaston; Wichern, Amanda M; Chambers, Michael J; Gonzalez, Ohmar N; Pahle, Mason U; Wagner, Joshua A; Robinson, J; Kragh, John F

doi:10.55460/yfse-v7we

Cited by 35 publications

(15 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…3,5 Noncompressible torso hemorrhage is a high-grade injury present in one or more of the following anatomic domains: thoracic cavity (including pulmonary parenchymal injuries), solid abdominal organ, major vascular, or pelvic trauma; plus, hemodynamic instability or the need for immediate hemorrhage control. 5,6 The National Trauma Data Bank estimates that more than 20,000 US civilians suffered from NCTH injury between 2007 and 2009, of which 45% were fatal 7 ; the same can be said for military personnel. Holcomb et al 8 reported that among deaths of Special Operations Forces personnel between 2001 and 2004, 15% were considered survivable, and of those 50% were caused by truncal hemorrhage.…”

mentioning

confidence: 99%

Gastroesophageal resuscitative occlusion of the aorta prolongs survival in a lethal liver laceration model

McCracken

Tiba²,

Mahmood³

et al. 2021

J Trauma Acute Care Surg

View full text Add to dashboard Cite

BACKGROUND: Noncompressible torso hemorrhage management remains a challenge especially in the prehospital setting. We evaluated a device designed to occlude the aorta from the stomach (gastroesophageal resuscitative occlusion of the aorta [GROA]) for its ability to stop hemorrhage and improve survival in a swine model of lethal liver laceration and compared its performance to resuscitative endovascular balloon occlusion of the aorta (REBOA) and controls. METHODS:Swine (n = 24) were surgically instrumented and a 30% controlled arterial hemorrhage over 20 minutes was followed by liver laceration. Animals received either GROA, REBOA, or control (no treatment) for 60 minutes. Following intervention, devices were deactivated, and animals received whole blood and crystalloid resuscitation. Animals were monitored for an additional 4 hours. RESULTS:The liver laceration resulted in the onset of class IV shock. Mean arterial blood pressure (MAP) (standard deviation) decreased from 84.5 mm Hg (11.69 mm Hg) to 27.1 mm Hg (5.65 mm Hg) at the start of the intervention. Seven of eight control animals died from injury prior to the end of the intervention period with a median survival (interquartile) time of 10.5 minutes (12 minutes). All GROA and REBOA animals survived the duration of the intervention period (60 minutes) with median survival times of 86 minutes (232 minutes) and 79 minutes (199 minutes) after resuscitation, respectively. The GROA and REBOA animals experienced a significant improvement in survival compared with controls ( p = 0.01). Resuscitative endovascular balloon occlusion of the aorta resulted in higher MAP at the end of intervention 114.6 mm Hg (22.9 mm Hg) compared with GROA 88.2 mm Hg (18.72 mm Hg) ( p = 0.024), as well as increased lactate compared with GROA 13.2 meq•L −1 (1.56 meq•L −1 ) versus 10.5 meq•L −1 (1.89 meq•L −1 ) ( p = 0.028). Histological examination of the gastric mucosa in surviving animals revealed mild ischemic injury from both GROA and REBOA. CONCLUSION: The GROA and REBOA devices were both effective at temporarily stanching lethal noncompressible torso hemorrhage of the abdomen and prolonging survival.

show abstract

mentioning

confidence: 99%

Gastroesophageal resuscitative occlusion of the aorta prolongs survival in a lethal liver laceration model

McCracken

Tiba²,

Mahmood³

et al. 2021

J Trauma Acute Care Surg

View full text Add to dashboard Cite

show abstract

“…Only one study by Gaspary et al [23] reported on the effectiveness during transport of JTQ application in a pre-hospital environment. Whilst other studies mentioned devices remaining in place during transport [29][30][31][37][38][39], it was not specifically assessed. An in-hospital case report by Croushorn et al [40] reported that the AAJT remained in place during transport from the emergency department to the operating theatre with no blood loss seen throughout transfer.…”

Section: Discussionmentioning

confidence: 99%

“…The CRoC tourniquet was not studied in pre-hospital trauma patients. Device efficacy was reported in the case report [29] and the case series [27], ranging from 70-100% for the SJT and JETT. Although the case report by Klotz et al [29] did not specifically assess the efficacy of the SJT during transport, they reported that it remained in place throughout the MEDEVAC.…”

Section: Pre-hospital Evidencementioning

confidence: 96%

“…Although the case report by Klotz et al [29] did not specifically assess the efficacy of the SJT during transport, they reported that it remained in place throughout the MEDEVAC. Application was only recorded in the case report including 1 trauma patient where the application time was <180 s to apply the SJT [29].…”

Section: Pre-hospital Evidencementioning

confidence: 99%

“…Of the 14 studies included for JTQ review, eight were conducted in 194 healthy human volunteers [16][17][18][19][20][21][22][23] (Table 2), 3 were conducted on 16 perfused human cadavers [24][25][26] (Table 3), and 2 case series [27,28] and 1 case report [29] on 21 trauma patients (Table 4). The total number of cadavers and volunteers was 210.…”

Section: Pre-hospital Feasability Evidencementioning

confidence: 99%

See 2 more Smart Citations

Use of Haemostatic Devices for the Control of Junctional and Abdominal Traumatic Haemorrhage: A Systematic Review

2022

View full text Add to dashboard Cite

Catastrophic haemorrhage accounts for up to 40% of global trauma related mortality and is the leading cause of preventable deaths on the battlefield. Controlling abdominal and junctional haemorrhage is challenging, especially in the pre-hospital setting or ‘under fire’, yet there is no haemostatic agent which satisfies the seven characteristics of an ‘ideal haemostat’. We conducted a systematic search of Embase, Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science to evaluate the feasibility and efficacy of three types of haemostatic devices. Participants included any trauma patient in a pre-hospital setting, perfused human cadavers, or healthy human volunteer simulations. The haemostatic devices reviewed were REBOA, iTClampTM, and four junctional tourniquets: AAJT, CRoC, JETT, and SJT. The SJT had the best user survey performance of the junctional tourniquets, and the four junctional tourniquets had an overall efficacy of 26.6–100% and an application time of 10–203 s. The iTClampTM had an efficacy of 60–100% and an application time of 10–60 s. REBOA had an efficacy of 71–100% and an application time ranging from 5 min to >80 min. In civilian and military trauma patients the use of junctional tourniquets, iTClamp, or REBOA, mortality varied from 0–100%. All of these studies were deemed low to very low in quality, hence the reliability of data presented in each of the studies is called into question. We conclude that despite limited data for these devices, their use in the pre-hospital environment or ‘under fire’ is feasible with the correct training, portable imaging, and patient selection algorithms. However, higher quality studies are required to confirm the true efficacy of these devices.

show abstract

Remote Damage Control Resuscitation

Peschman

Glassberg

Jenkins

2019

Damage Control Resuscitation

View full text Add to dashboard Cite

First Case Report of SAM(r) Junctional Tourniquet Use in Afghanistan to Control Inguinal Hemorrhage on the Battlefield

Cited by 35 publications

References 0 publications

Gastroesophageal resuscitative occlusion of the aorta prolongs survival in a lethal liver laceration model

Gastroesophageal resuscitative occlusion of the aorta prolongs survival in a lethal liver laceration model

Use of Haemostatic Devices for the Control of Junctional and Abdominal Traumatic Haemorrhage: A Systematic Review

Remote Damage Control Resuscitation

Contact Info

Product

Resources

About