iPhoneIcon_BigThere´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 case
Screen Shot 2014-07-27 at 06.23.01The 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, while there are other treatments to help the body function as the 7-Keto DHEA Fat Burner – All Natural 7K DHEA Cream for Weight Loss – DHEA for Men & Women to keep the body healthy and clean. 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.

Take-home message
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. 

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  1. Viking One says:

    Dear Friend
    You Do apparently attend the wrong courses….
    Both internal as well as external manual aortic compression is taught on the live tissue course and the Advanced prehospital care for physicians course held by the air ambulance department in Oslo.

    • K says:

      Hi Viking One,
      It seems I do.
      Anyhow, the concept is still obscure enough to make a case report in Annals.

  2. This is a classic example and case report as to the origins of the AAJT. Penetrating injuries of proximal femoral and iliac vessels are a common cause of death on the battlefield. Previous studies have shown that by applying between 80 to 140 pounds of pressure externally over the distal abdominal aorta, flow can be ceased in the common femoral artery. (1)

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  3. Matthew Douma says:

    Thanks for taking note of our modest case. It would be apt to refer to the first responder as amply bearded and suitably burly. In the absence of suitable alternative intervention, I wonder if external aortic compression might be worth considering by rescuers of any burliness, for patients in extremis, as long as it does not delay definitive care? Without any conflicts to disclose and having performed the maneuver but never used a device, the AA&JT described by Mr Crossley appears to be an ingenious device worthy of consideration and further evaluation. We picture manual compression, followed by device compression or perhaps REBOA then definitive care. Huge fans of Scancrit – thanks again!

  4. Certainly seems easier than prehospital REBOA – ie : just us a fist or even better a junctional tourniquet.

    Wonder how well they work?

  5. Valerio says:

    Great stuff Mate….I teach This manouvres to my medics as extreme ratio…Unfortunately is very hard to obtain good outcomes… Too many variables involved…weight of wounded, weight of performer, ability to generate enough pressure; knee technique maybe better….In any case it’s worthy to try!!!…

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  7. Great post! I was involved in a case about the time this blog was written- massive unexpected haemorrhage from unrecognised placenta accreta in theatre. She arrested about 3 min after haemorrhage started with an arterial line already in situ – and definitely no output – and I got an obstetric registrar to perform this maneouvre – this plus some volume and adrenaline definitely helped. Oncology surgeon came and opened her abdomen and cross clamped her aorta to get definitive control. 12 units blood and massive amount of fibrinogen reqd though. There are a few studies on this technique published in obstetric journals. IMHO Seems like a much quicker technique to implement than reboa for any massive haemorrhage below the umbilicus

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