THE MOTHER OF ALL TOURNIQUETS

There has been a renewed interest in tourniquet use in the recent years. After successful battlefield use, it has come back into service in prehospital response. The aim is to stop otherwise uncontrollable arterial bleeding from limbs. Sometimes, with larger vessels and limbs, you may have to use more than one tourniquet. But what about the mother of all vessels?

Prehospital trauma response have long pondered how to deal with severe abdominal and pelvic bleeding. The best answer so far has been a mix of blood and gasoline. Some also advocate emergency thoracotomy to control the aorta in abdominal/pelvic exsanguination. Now, there’s a possible simpler solution. Introducing the Abdominal Aortic Tourniquet.

It’s a band that goes around the abdomen, with an inflatable wedge-shaped bladder to push down on the abdomen and compress the aorta. It’s supposed to clamp the aorta at the level of the navel, thus keeping the kidneys circulated. Two american emergency doctors came up with the idea after battlefield experience combined with findings from studies on the pressure needed to occlude the abdominal aorta back in the civilian world.

The inventors say it has been used to successfully compress the aorta of pigs for up to an hour without damage to the gut or raised K+ levels. Hopefully the kidneys survived too. On healthy humans it has been applied for short durations and apparently shown to be effective at stopping blood flow through the aorta.

They also talk about how it could have a place in other settings, for use as a temporary measure in AAA ruptures, or even for restricting blood volume and flow to the upper body in CPR scenarios.

I haven’t been able to dig up any of the articles on studies of the external pressure needed to occlude the aorta, nor on the pig or human tests. I don’t even know if they have been published. But if anyone finds links to something like that, it would be great to hear from you.

It will certainly be interesting to see if this XXXXXXL blood pressure cuff will prove itself in real trials.

Read about it here!

Addendum: Here’s an earlier application of an abdominal aortic tourniquet: This article in Anesthesia & Analgesia from 1964 where they separated the blood flow of the upper and lower parts of the body during chemo treatment. Thanks, @rfdsdoc