There´s an interesting case report in Annals of Emergency Medicine. It describes a case where massive bleeding from the lower abdomen and pelvis was successfully stopped by a burly first responder who applied manual aortic compression.
The victim was young man who received multiple gunshots to his lower abdomen, left flank and proximal thigh. All bled profusely and the victim went into unconscious haemorrhagic shock.
Luckily there was healthcare professional just nearby who immediately responded. Direct compression of one wound did´t help as the victim just kept bleeding out from the remaining two.
The first responder solved this by instead applying massive bimanual force to the aorta at the level of the epigastrium. Immediately all external bleeding from the distal wounds stopped and within short time the patient regained consciousness and recovered to a GCS of 14. Interestingly, as the manual compression was demonstrated and handed over to a rescuer of smaller build, external bleeding resumed and the victim again went unconscious.
This could by explained how the second responder weighed a lot less. Less than 150 lbs compared to ´more than 200 lbs´. (Less than 70kg vs more than 90kg) As soon as the larger responder reapplied compression the bleeding stopped and again the patient recovered. This way they kept the patient alive to local ED where he was unfortunately PLEd after a couple of hours of emergency surgery and massive transfusions.
I know military docs teach troops to compress the epigastric aorta using a fist or a knee. Despite that and the no-brainerish nature of the manoeuvre it is hardly mainstream. None of the trauma courses and training I have attended mentioned it. Perhaps because a lot of people won´t be able to generate sufficient force. One study I found demonstrated how 80-120 pounds (35-55 kg) of pressure is required to compress the aorta through the abdominal wall given that pressure is applied in the right spot at all.
Case report lives here:
Temporization of penetrating abdominal-pelvic trauma with manual external aortic compression: a novel case report. Douma M, Smith KE, Brindley PG. Ann Emerg Med. 2014 Jul;64(1):79-81.