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

This entry was posted in Emergency Medicine, Prehospital Medicine, Tech, Trauma. Bookmark the permalink.

4 Responses to THE MOTHER OF ALL TOURNIQUETS

  1. Pingback: SNPeCPR | ScanCrit.com

  2. The Abdominal Aortic Tourniquet becomes the first truncal tourniquet to
    save life in both upper and lower junctional hemorrhage

    Birmingham, AL – June 27,2013 Compression Works LLC is excited to announce
    that the Abdominal Aortic Tourniquet became the first truncal tourniquet to save
    life in both upper and lower junctional hemorrhage earlier this month.

    The Journal of Special Operations Medicine published a case report on a
    casualty with lower junctional hemorrhage that survived after application of the
    AAT in late Afghanistan earlier this year. This was published in the Summer 2013
    edition and provides a detailed accounting of how the tourniquet saved the life of
    soldier who was dying despite current best practice treatment.

    On June 7th a civilian gun shot victim in Birmingham, AL in class IV hemorrhagic
    shock survived a wound involving the left axillary region because of the AAT. The
    injury destroyed 6 cm of the patient’s brachial artery. The AAT was applied to the
    left axilla and secured around the opposite shoulder. IT controlled the
    hemorrhage and the patient survived the injury.

    The AAT is the only device able to displace enough soft tissue to stop blood flow
    through the proximal subclavian artery from the axilla. The case report is pending
    review for publication at this time. More information can be obtained on the
    company’s website, http://www.compressionworks.net.

    The AAT is the only device capable of stopping pelvic junctional bleeding as well
    as upper torso junctional bleeding. This is a problem that accounts for close to
    30% of deaths on the battlefield. Difficult to control hemorrhage in these areas
    are also a problem in the civilian pre-hospital setting. Extremity tourniquets
    cannot work because they cannot be applied above the point of wounding. New
    hemostatic dressings do not work because of the large areas required to fill when
    these dressings.

    The Abdominal Aortic Tourniquet is available exclusively in the United States
    from Speer Operational Technologies (www.speeroptech.som) and in the EU
    from Fenton Pharmaceuticals Ltd in London, UK
    (www.fentonpharmaceuticals.com)

  3. Pingback: Trauma! Extremity Arterial Hemorrhage

  4. Pingback: Assessment and Management of Severe Arterial Extremity Hemorrhage

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