Long-term consequences of abdominal aortic and junctional tourniquet for hemorrhage control

Kheirabadi, Bijan S.; Terrazas, Irasema B; Miranda, Nahir; Voelker, Amber N.; Klemcke, Harold G.; Brown, A. C.; Dubick, Michael A.

doi:10.1016/j.jss.2018.05.017

Cited by 30 publications

(16 citation statements)

References 8 publications

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“…However, only 70% believed direct pressure should be used to manage such bleeding. Some recommended abdominal tourniquets, which are controversial, time-consuming, and not carried by many healthcare providers during a primary triage assessment, although victims’ clothes might be used for such a maneuver [ 48 , 49 ]. To the best of our knowledge, direct pressure is the most feasible intervention in proximal non-compressible injury in a major incident setting [ 49 ].…”

Section: Discussionmentioning

confidence: 99%

“…Some recommended abdominal tourniquets, which are controversial, time-consuming, and not carried by many healthcare providers during a primary triage assessment, although victims’ clothes might be used for such a maneuver [ 48 , 49 ]. To the best of our knowledge, direct pressure is the most feasible intervention in proximal non-compressible injury in a major incident setting [ 49 ]. Tourniquets on extremities have also been debated for years, with several experts recommending their use while others do not.…”

Section: Discussionmentioning

confidence: 99%

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Developing a translational triage research tool: part two—evaluating the tool through a Delphi study among experts

Khorram‐Manesh

Burkle

Nordling

et al. 2022

Scand J Trauma Resusc Emerg Med

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Background There are different prehospital triage systems, but no consensus on what constitutes the optimal choice. This heterogeneity constitutes a threat in a mass casualty incident in which triage is used during multiagency collaboration to prioritize casualties according to the injuries’ severity. A previous study has confirmed the feasibility of using a Translational Triage Tool consisting of several steps which translate primary prehospital triage systems into one. This study aims to evaluate and verify the proposed algorithm using a panel of experts who in their careers have demonstrated proficiency in triage management through research, experience, education, and practice. Method Several statements were obtained from earlier reports and were presented to the expert panel in two rounds of a Delphi study. Results There was a consensus in all provided statements, and for the first time, the panel of experts also proposed the manageable number of critical victims per healthcare provider appropriate for proper triage management. Conclusion The feasibility of the proposed algorithm was confirmed by experts with some minor modifications. The utility of the translational triage tool needs to be evaluated using authentic patient cards used in simulation exercises before being used in actual triage scenarios.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Developing a translational triage research tool: part two—evaluating the tool through a Delphi study among experts

Khorram‐Manesh

Burkle

Nordling

et al. 2022

Scand J Trauma Resusc Emerg Med

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show abstract

“…The other approved mechanical method available for aortic occlusion is the Abdominal Aortic Junctional Tourniquet (AAJT). The AAJT has been demonstrated to be capable of occluding the infrarenal aorta and thus may be effective as an aortic zone 3 occlusion device for control of bleeding below that level such as pelvic hemorrhage 9,21–24 . It achieves this by the mechanical targeting of pressure directly downward towards the abdominal aorta.…”

Section: Aortic Occlusionmentioning

confidence: 99%

“…The AAJT has been demonstrated to be capable of occluding the infrarenal aorta and thus may be effective as an aortic zone 3 occlusion device for control of bleeding below that level such as pelvic hemorrhage. 9,[21][22][23][24] It achieves this by the mechanical targeting of pressure directly downward towards the abdominal aorta. This is different from the previously used technologies called the military antishock trousers (MAST) or pneumatic antishock garments (PASG) which have been determined to be ineffective for treating abdominal or pelvic tamponade of severe arterial bleeding and are no longer recommended.…”

mentioning

confidence: 99%

A review of two emerging technologies for pre‐hospital treatment of non‐compressible abdominal hemorrhage

2022

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“…However, too broad of a pressurized area and ambiguous vascular locating methods are ubiquitous among existing EHCDs, often resulting in excessive peripheral tissue/organ compression or high compression segments of targeted arteries. The resultant ischemic/mechanical injuries and limb dysfunction obviously inhibit the promotion of EHCDs in clinical practice (8)(9)(10).…”

mentioning

confidence: 99%

Imaging Anatomy and Surface Localization of External Control Device - Target ed Arteries for Noncompressible Torso Hemorrhage

zhang

liu

et al. 2020

Preprint

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Background: Noncompressible torso hemorrhage (NCTH) is the main cause of prehospital death due to war injury. External hemorrhage control devices (EHCDs) are effective in reducing the death risk of NCTH, but the pressurized area is too large to prevent serious organ damage. This study aims to establish the surface localization strategy of EHCDs based on anatomical features of NCTH-related arteries through human CT images to facilitate the optimal design and application of EHCDs and eventually reduce relevant injuries. Methods: Images of 200 patients aged 18-65 years who underwent abdominal contrast-enhanced CT scans were collected. Anatomical parameters such as the length and diameter of the aortic bifurcation (AB), common iliac artery (CIA), external iliac artery (EIA) and common femoral artery (CFA) were measured, and positional relationships among EHCD-targeted arteries, umbilicus, anterior superior iliac spine (ASIS) and pubic tubercle (PT) were determined. The accuracy of surface localization was verified by 3D-printed mannequins of 20 real patients. Results: The angle and diameter of the AB were 47.1±10.5° and 17.8±2.7 mm, respectively. The AB was 7.5±8.6 mm to the left of umbilicus. The left CIA and right EIA were longer than the contralateral CIA and right EIA (p=0.038 and p=0.000, respectively). The average length of CFA was 39.0±16.6 mm. The CIA was wider than the EIA and the CFA (p=0.000). The distance between the artery and surface decreased from the CIA to the CFA (p=0.000). The vertical distance between the CIA terminus and the ipsilateral AB-ASIS line was 19.6±8.2 mm, and the left and right perpendicular intersections were located at the upper 1/3 and 1/4 of the AB-ASIS line, respectively. The length ratio of EIA-ASIS to ASIS-PT was 0.6:1. The length of the surface location/actual subpoint-ASIS was significantly correlated (p≤0.002), and the vertical distance between the two points of the same artery was ≤ 5.5 mm. Conclusion: The arterial localization strategy established via anatomical investigation was consistent with the actual situation. The data are necessary for improving EHCD design, precise hemostasis and EHCD-related collateral injuries.

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Long-term consequences of abdominal aortic and junctional tourniquet for hemorrhage control

Cited by 30 publications

References 8 publications

Developing a translational triage research tool: part two—evaluating the tool through a Delphi study among experts

Developing a translational triage research tool: part two—evaluating the tool through a Delphi study among experts

A review of two emerging technologies for pre‐hospital treatment of non‐compressible abdominal hemorrhage

Imaging Anatomy and Surface Localization of External Control Device - Target ed Arteries for Noncompressible Torso Hemorrhage

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Long-term consequences of abdominal aortic and junctional tourniquet for hemorrhage control

Cited by 30 publications

References 8 publications

Developing a translational triage research tool: part two—evaluating the tool through a Delphi study among experts

Developing a translational triage research tool: part two—evaluating the tool through a Delphi study among experts

A review of two emerging technologies for pre‐hospital treatment of non‐compressible abdominal hemorrhage

Imaging Anatomy and Surface Localization&nbsp;of External Control Device - Target ed&nbsp;Arteries&nbsp;for Noncompressible Torso Hemorrhage

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Imaging Anatomy and Surface Localization of External Control Device - Target ed Arteries for Noncompressible Torso Hemorrhage