Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-28T12:12:09.507Z Has data issue: false hasContentIssue false
  • English
  • Français

Abdominal Aortic and Iliac Artery Compression Following Penetrating Trauma: A Study of Feasibility

Published online by Cambridge University Press:  10 June 2014

Matthew Douma Open the ORCID record for Matthew Douma [Opens in a new window]  and
Peter George Brindley
Matthew Douma*
Affiliation:
Collaborative Program in Resuscitation Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Peter George Brindley
Affiliation:
Division of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada
*
Correspondence: Matthew Douma RN, BSN, ENC(C), CNCC(C) 11301 102 Ave. Edmonton, Alberta, Canada E-mail matthewjdouma@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

Penetrating junctional trauma is a leading cause of preventable death on the battlefield. Similarly challenging in civilian settings, exsanguination from the vessels of the abdomen, pelvis, and groin can occur in moments. Therefore, iliac artery or abdominal aortic compression has been recommended. Based on prior research, 120 lbs (54 kg) or 140 lbs (63 kg) of compression may be required to occlude these vessels, respectively. Whether most rescuers can generate this amount of compression is unknown.

Objective

To determine how many people in a convenience sample of 44 health care professionals can compress 120 lbs and 140 lbs.

Methods

This study simulated aortic and iliac artery compression. Consent was obtained from 44 clinicians (27 female; 17 male) from two large urban hospitals in Edmonton, Alberta, Canada. Participants compressed the abdominal model, which consisted of a medical scale and a 250 ml bag of saline, covered by a folded hospital blanket and placed on the ground. In random order, participants compressed a force they believed maintainable for 20 minutes (“maintainable effort”) and then a maximum force they could maintain for two minutes (“maximum effort”). Compression was also performed with a knee. Descriptive statistics were used to evaluate the data.

Results

Compression was directly proportional to the clinician's body weight. Participants compressed a mean of 55% of their body weight with two hands at a maintainable effort, and 69% at a maximum effort. At maintainable manual effort, participants compressed a mean of 86 lbs (39 kg). Sixteen percent could compress over 120 lbs, but none over 140 lbs. At maximum effort, participants compressed a mean of 108 lbs (48 kg). Thirty-four percent could compress greater than 120 lbs and 11% could compress greater than 140 lbs. Using a single knee, participants compressed a mean weight of 80% of their body weight with no difference between maintainable and maximum effort.

Conclusion

This work suggests that bimanual compression following penetrating junctional trauma is feasible. However, it is difficult, and is not likely achievable or sustainable by a majority of rescuers. Manual compression (used to temporize until device application and operative rescue) requires a large body mass. To maintain 140 lbs of compression (for example during a lengthy transport), participants needed to weigh 255 lbs (115 kg). Alternatively, they needed to weigh 203 lbs (92 kg) to be successful during brief periods. Knee compression may be preferable, especially for lower-weight rescuers.

DoumaM , BrindleyPG . Abdominal Aortic and Iliac Artery Compression Following Penetrating Trauma: A Study of Feasibility. Prehosp Disaster Med. 2014;29(3):1-4.

Keywords

hemorrhagejunctional traumapenetrating trauma
Type
Brief Report
Information
Prehospital and Disaster Medicine , Volume 29 , Issue 3 , June 2014 , pp. 299 - 302
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Markov, NP, DuBose, JJ, Scott, D, et al. Anatomic distribution and mortality of arterial injury in the wars in Afghanistan and Iraq with comparison to a civilian benchmark. J Vasc Surg. 2012;56(3):728-736.CrossRefGoogle ScholarPubMed
2. Eastridge, BJ, Mabry, RL, Seguin, P, et al. Death on the battlefield (2001-2011). J Trauma Acute Care Surg. 2012;73:S431-S437.CrossRefGoogle ScholarPubMed
3. Pannell, D, Brisebois, R, Talbot, M, et al. Causes of death in Canadian Forces members deployed to Afghanistan and implications on Tactical Combat Casualty Care Provision. J Trauma Inj Infect Crit Care. 2011;71(5 Supp 1):S401-S407.Google ScholarPubMed
4. Parker, P. Consensus statement on decision making in junctional trauma care. J R Army Med Corps. 2011;157(3 Suppl 1):S293-S296.CrossRefGoogle ScholarPubMed
5. Katzenell, U, Ash, N, Tapia, A, et al. Analysis of the causes of death of casualties in field military setting. Mil Med. 2012;177(9):1065-1068.CrossRefGoogle ScholarPubMed
6. Kragh, JF, Murphy, C, Dubick, MA, et al. New tourniquet device for battlefield hemorrhage control. US Army Med Dep J. 2011;(April-June):38-55.Google ScholarPubMed
7. Kelly, JF, Ritenour, AE, McLaughlin, DF, et al. Injury severity and causes of death from Operation Iraqi Freedom and Operation Enduring Freedom: 2003-2004 versus 2006. J Trauma Inj Infect Crit Care. 2008;64(Supplement):S21-S27.Google ScholarPubMed
8. Kragh, JF, Littrel, ML, Jones, JA, et al. Battle casualty survival with emergency tourniquet use to stop limb bleeding. J Emerg Med. 2011;41(6):590-597.CrossRefGoogle ScholarPubMed
9. Walker, NM, Eardley, W, Bonner, T, Clasper, J. UK combat-related pelvic junctional vascular injuries 2008-2011: implications for future intervention. Bone Jt J Orthop Proc Suppl. 2013;95‐B(SUPP 8):13.Google Scholar
10. Lyon, M, Shiver, SA, Greenfield, EM, et al. Use of a novel abdominal aortic tourniquet to reduce or eliminate flow in the common femoral artery in human subjects. J Trauma Acute Care Surg. 2012;73:S103-S105.CrossRefGoogle ScholarPubMed
11. Taylor, D, Coleman, M, Parker, P. The evaluation of an abdominal aortic tourniquet for the control of pelvic and lower limb hemorrhage. Bone Jt J. 2013;95‐B(Supp 26):8.Google Scholar
12. Blaivas, M, Shiver, S, Lyon, M, et al. Control of hemorrhage in critical femoral or inguinal penetrating wounds--an ultrasound evaluation. Prehosp Disaster Med. 2006;21(6):379-382.CrossRefGoogle ScholarPubMed
13. Soltan, MH, Sadek, RR. Experience managing postpartum hemorrhage at Minia University Maternity Hospital, Egypt: no mortality using external aortic compression. J Obstet Gynaecol Res. 2011;37(11):1557-1563.CrossRefGoogle ScholarPubMed
14. Kin, N, Hayashida, M, Chang, K, et al. External manual compression of the abdominal aorta to control hemorrhage from a ruptured aneurysm. J Anesth. 2002;16(2):164-166.CrossRefGoogle ScholarPubMed
15. Acheson, EM, Kheirabadi, BS, Deguzman, R, et al. Comparison of hemorrhage control agents applied to lethal extremity arterial hemorrhages in swine. J Trauma Inj Infect Crit Care. 2005;59(4):865-875.Google ScholarPubMed
16. American College of Surgeons Committee on Trauma. Advanced Trauma Life Support for Doctors. 9th ed. Chicago, Illinois USA; 2012.Google Scholar
17. Campbell, J. ITLS for Emergency Providers, 7th ed. Upper Saddle River, New Jersey USA: Prentice Hall; 2011.Google Scholar
18. National Association of Emergent Medical Technicians and American College of Surgeons Committee on Trauma. Prehospital Trauma Life Support, 7th ed. Burlington, Massachusetts USA: Jones & Bartlett Learning; 2011.Google Scholar