Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-10T07:11:59.424Z Has data issue: false hasContentIssue false
  • English
  • Français

The Effect of Anti-Shock Garments on Prehospital Survival: The Need for Controlled Clinical Trials

Published online by Cambridge University Press:  28 June 2012

Paul E. Pepe ,
William H. Bickell  and
Kenneth L. Mattox
Paul E. Pepe
Affiliation:
City of Houston, Emergency Medical Services, Houston, Texas, U.S.A.
William H. Bickell
Affiliation:
Baylor College of Medicine and the Institute of Surgical Research, Fort Sam Houston, Texas, U.S.A.
Kenneth L. Mattox
Affiliation:
Ben Taub General Hospital, Houston, Texas, U.S.A.
Get access Rights & Permissions [Opens in a new window]

Abstract

There exists strong sentiment, among emergency medical personnel and physicians alike, that the pneumatic anti-shock garment (PASG) “saves lives.” As a result, controlled studies have been criticized as the “withholding of important therapy.” The purpose of this presentation is to confirm the need for controlled clinical trials of the PASG. Despite an early report that the PASG offered no advantage in terms of the presenting emergency center Trauma Score (TS), similar disparagements have continued, particularly because survival data were not discussed. The present report is a pilot analysis of the effect of the PASG on the prehospital survival of patients arriving at an urban trauma center in the United States. In the study, sixty-eight patients were assigned randomly to control and PASG groups in a prospective investigation involving injured patients with systemic hypotension. The 32 control patients, whose mean initial systolic blood pressure (BP) was 59 ± 32 mm Hg, and the 36 PASG-treated patients, whose mean initial BP was 55 ± 31 mm Hg, were found to be well matched for age, sex, type and location of injuries, initial field TS; response, field management, and transport times; and the total amount of intravenous crystalloid infused. The results demonstrated no significant difference between the control and PASG-treated groups in terms of those pronounced dead on arrival at the trauma center (9/32 vs. 10/36). Further studies are therefore justified to determine how the PASG affects the long-term morbidity and mortality of injury victims, particularly those within certain sub-groups such as penetrating abdominal versus those with penetrating thoracic injuries. This report reaffirms the need for early responsible, scientific scrutiny of prehospital interventions.

Type
Research Article
Information
Prehospital and Disaster Medicine , Volume 3 , Issue 1: Contributions from the Third World Congress on Emergency and Disaster Medicine, Rome, Italy, May, 1983 , 1987 , pp. 40 - 45
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1987

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.Kaplan, BH.: (Letter to the Editor) MAST. Emer Dept News VII: 6, June 1985, p.2.Google Scholar
2.Caroline, NL: Emergency Care in the Streets, 2nd ed. Boston, Little Brown & Co, 1983.Google Scholar
3.American College of Surgeons Committee on Trauma: Advanced Trauma Life Support (ATLS) Course, Chicago, American College of Surgeons, 1984.Google Scholar
4.National Training Course, Emergency Medical Technician, Paramedic, Module 1–15, Superintendent of Documents, U.S. Government Printing Office, Washington, D.C., 1980.Google Scholar
5. Texas Department of Health, 9 Tex. Reg. 2823 (1984) Codified at 25 Tex Admin. (ODE & 157.68).Google Scholar
6.Trunkey, DD, Lewis, FR.: Current therapy of trauma 1984–85 B.C. Decker, Philadelphia, 1984. p.1.Google Scholar
7.Wayne, MA, MacDonald, SC: Clinical evaluation of the anti-shock trouser: Retrospective analysis of five years experience. Ann Emerg Med 1983;12:342–347.CrossRefGoogle Scholar
8.Kaback, KR, Sanders, AB, Meislins, HW: MAST suit update. JAMA 1984;222:2598–2603.CrossRefGoogle Scholar
9.MacKersie, RC, Christensen, JM, Lewis, FR: The prehospital use of external counterpressure: Does MAST make a difference? J Trauma 1984;24:882–888.CrossRefGoogle Scholar
10.Bass, RR, Alison, EJ, Reines, HD.: Tight compartment syndrome without lower extremity trauma following application of PAS Trousers. Ann Emerg Med 12:382–384, 1983.CrossRefGoogle Scholar
11.Brotman, S, Browner, BD, Cox, EF.: MAS Trouser improperly applied causing a compartment syndrome in lower extremity trauma. J Trauma 22:598–599, 1982.CrossRefGoogle ScholarPubMed
12.Cogbill, TH, Good, JT, Moore, EE.: Pulmonary function after military antishock trouser inflation. Surg Forum 32:302, 1981.Google Scholar
13.Frampton, MW.: Lower extremity ischemia associated with use of military antishock trousers. Ann Emer Med 13:1115–1160, 1984.CrossRefGoogle ScholarPubMed
14.Goodenberger, D.: Thrombosis as complication of MAST use. Ann Emerg Med 10:395, 1981.CrossRefGoogle ScholarPubMed
15.Johnson, BE.: Anterior tibial compartment syndrome following use of MAST suit. Ann Emerg Med 10:209–210, 1981.CrossRefGoogle ScholarPubMed
16.Maull, K, Capehart, JE, Cardea, JA, et al: Limb loss following antishock trousers (MAST) application. J Trauma 21:60–62, 1980.CrossRefGoogle Scholar
17.Palafox, BA, Johnson, MN, McEwen, DK, et al: ICP changes following application of the MAST suit. J Trauma 21:55–59, 1981.CrossRefGoogle ScholarPubMed
18.Wangensteen, SL, de Holl, JD, Ludewig, RM, et al: The detrimental effect of the G-suit in hemorrhagic shock. An Surg 170:187–192, 1969.CrossRefGoogle ScholarPubMed
19.Williams, TM, Knopp, R, Ellyson, JH: Compartment syndrome after anti-shock trouser use without lower-extremity trauma. J. Trauma 22:595–597, 1982.CrossRefGoogle ScholarPubMed
20. “Mcllvain Files” Military Anti-shock Trousers” KHOU-TV, Six p.m. News, 06/12/84.Google Scholar
21.Bickell, WH, Pepe, PE, Wyatt, CH, et al: Effect of antishock trousers on the trauma score. Ann Emerg Med 1985;14:218–222.CrossRefGoogle ScholarPubMed
22.Champion, HR, Sacco, WJ, Carnazzo, AJ, et al: Trauma score. Crit Care Med 1981;9:672–676.CrossRefGoogle ScholarPubMed
23.Civetta, JM, Nussenfeld, SR, Rowe, TR, et al: Prehospital use of the military anti-shock trouser (MAST). JACEP 1976;5:581–587. 29.CrossRefGoogle ScholarPubMed
24.Kaplan, BC, Civetta, JM, Nagel, EL, et al: Military anti-shock trousers in civilian pre-hospital emergency care. J Trauma 1973;13:843–848.CrossRefGoogle Scholar
25.Lilja, GP, Batalden, DJ, Adams, BE, et al: Value of the counterpressure suit (MAST) in pre-hospital emergency care. Minn Med 1973;58:540–543.Google Scholar
26.McSwain, NE: Pneumatic trousers and the management of shock. J. Trauma 1977; 17:719–274.CrossRefGoogle ScholarPubMed
27.Pelligra, R, Sandberg, ED.: Control of intractable abdominal bleeding by external counterpressure. JAMA 241:708–713, 1979.CrossRefGoogle ScholarPubMed
28.American College of Surgeons Committee on Trauma: Advanced Trauma Life Support (ATLS) Course. Chicago, American College of Surgeons, 1981.Google Scholar
29.Sacco, WJ, Champion, HR, Gainer, PS, et al: The trauma score as applied to penetrating trauma. Ann Emerg Med 1984;13:415–418.CrossRefGoogle ScholarPubMed