Compression devices for temporary hemostasis in injuries of the abdomen and adjacent ileo‑inguinal areas (literature review)
https://doi.org/10.24884/2072-6716-2022-23-1-50-61
Abstract
The review analyzes the available literature on the experimental justification and experience of practical application of existing promising devices for stopping intra‑abdominal and external bleeding in the ilio‑inguinal regions by creating an external local compression. Objective: to analyze the order of application, effectiveness and parameters of safe use of “abdominal tourniquet” for local compression of the abdomen and ilio‑inguinal areas with continued bleeding into the peritoneal cavity and pelvic tissue, damage to the vessels of the ilio‑femoral segment, as well as with high hip detachments, when it is impossible to fix the classic tourniquet. Materials and methods. The analysis of modern domestic and foreign literature, the sacred relevance of the pathology under consideration, the constructive features of the main models of devices for creating external compression in the abdomen and adjacent areas of the body, the experience and results of their application in laboratory and real conditions is carried out. Results. The obtained data allow us to assert that today the following four models belong to the main products of the above‑described purpose: AAJT (Abdominal Aortic and Junctional Tourniquet), CRoC (Combat Ready Clamp), JETT (Junctional Emergency Treatment Tool), SJT (SAM Junctional Tourniquet). The considered devices for creating local compression provide temporary hemostasis in intra‑abdominal bleeding, injury of large vessels of the ilio‑inguinal regions and high separation of the thighs, but their use has a number of features that affect the effectiveness of stopping blood flow. Conclusion. The considered compression devices have design features and limitations, so when creating a domestic analog, additional data on the algorithm of use is needed, depending on the area of the wound and the intended source of bleeding, the timing of fixation, as well as the possible combination of this method of temporary hemostasis with other promising methods of stopping bleeding at the pre‑hospital stage.
About the Authors
I. M. SamokhvalovRussian Federation
Igor M. Samokhvalov
St. Petersburg
A. N. Petrov
Russian Federation
Aleksandr N. Petrov
St. Petersburg
M. S. Grishin
Russian Federation
Maksim S. Grishin
St. Petersburg
K. P. Golovko
Russian Federation
Konstantin P. Golovko
St. Petersburg
References
1. Samokhvalov I. M., Goncharov A. V., Chirskij V. S., Nosov A. M., Golovko K. P., Badmaev V. B. et al. “Potentially survivable” casualties — reserve to reduce pre-hospital lethaility in injuries and traumas. Emergency medical care, 2019, Vol. 3, No 20, pp. 10–17 (In Russ.).
2. Chaudery M., Clark J., Wilson M. H., Bew D., Yang G. Z., Darzi A. Traumatic intra-abdominal hemorrhage control: has current technology tipped the balance toward a role for prehospital intervention? // J. Trauma Acute Care Surg. 2015. Vol. 78, No 1. P. 153–163.
3. Eastridge B.J., Stansbury L. G., Stinger H., Blackbourne L., Holcomb J. B. Forward Surgical Teams provide comparable outcomes to combat support hospitals during support and stabilization operations on the battlefield // J. Trauma. 2009. Vol. 66, No 4. P. 48–50.
4. Kotiv B. N., Samokhvalov I. M., Badalov V. I., Goncharov A. V., Severin V. V., Reva V. A. et al. Battle-field surgery in the beginning of 21st century. Military Medical Journal, 2016, Vol. 337, No 5. P. 4–10 (In Russ.).
5. Momburg FA. The artificial emptying of the lower half of the body // Zentralblatt für Chirurgie (Heft 23 and Heft 41). 1908. Р. 697–699, 1193–2294.
6. Lateef F., Kelvin T. Military anti-shock garment: Historical relic or a device with unrealized potential? // J. Emerg Trauma Shock. 2008. Vol. 1, No 2. P. 63–69.
7. Nekrasov A. A., Savelyev O. V., Igonin V. V., Golovlev V. N. Catatrauma: the use of antishock suit “Kashtan” with blunt abdominal trauma with the hypovolemic shock clinic at the prehospital stage. The Bulletin of East Siberian Scientific Center Siberian Department of the RAMS, 2011, Vol. 4, P. 79–80 (In Russ.).
8. Kragh J. F. Jr., Murphy C., Dubick M. A., Baer D. G., Johnson J., Blackbourne L. H. New tourniquet device concepts for battlefield hemorrhage control // US Army Med. Dep. J. 2011. P. 38–48.
9. Blaivas M., Shiver S., Lyon M., Adhikari S. Control of hemorrhage in critical femoral or inguinal penetrating wounds — an ultrasound evaluation // Prehosp Disaster Med. 2006. Vol. 21, No 6. P. 379–382.
10. Lyon M., Shiver S. A., Greenfield E. M., Reynolds B. Z., Lerner E. B., Wedmore I. S. 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. Vol. 73, No 2. P. 103–105.
11. Cotte J., Cungi P. J., Montcriol A. Experimental evaluation of the Combat Ready Clamp // J. Trauma Acute Care Surg. 2013. Vol. 75, No 4. P. 747–748.
12. Kheirabadi B.S., Terrazas I. B., Hanson M. A., Kragh J. F. Jr., Dubick MA, Blackbourne LH. In vivo assessment of the Combat Ready Clamp to control junctional hemorrhage in swine // J. Trauma Acute Care Surg. 2013. Vol. 74, No 5. P. 1260–1265.
13. Taylor D.M., Coleman M., Parker P. J. The evaluation of an abdominal aortic tourniquet for the control of pelvic and lower limb hemorrhage // Mil. Med. 2013. Vol. 178, No 11. P. 1196–1201.
14. Johnson J.E., Sims R. K., Hamilton D. J., Kragh J. F. Jr. Safety and Effectiveness Evidence of SAM(r) Junctional Tourniquet to Control Inguinal Hemorrhage in a Perfused Cadaver Model // J. Spec. Oper. Med. 2014. Vol. 14, No 2. P. 21–25.
15. Gates K.S., Baer L., Holcomb J. B. Prehospital emergency care: evaluation of the junctional emergency tourniquet tool with a perfused cadaver model // J. Spec. Oper. Med. 2014. Vol. 14, No 1. P. 40–44.
16. Kragh J. F. Jr., Parsons D. L., Kotwal R. S., Kheirabadi B. S., Aden J. K., Gerhardt R. T. et al. Testing of junctional tourniquets by military medics to control simulated groin hemorrhage // J. Spec. Oper. Med. 2014. Vol. 14, No 3. P. 58–63.
17. Lyon M., Johnson D., Gordon R. Use of a Novel Abdominal Aortic and Junctional Tourniquet to Reduce or Eliminate Flow in the Brachial and Popliteal Arteries in Human Subjects // Prehosp. Emerg. Care. 2015. Vol. 19, No 3. P. 405–408.
18. Kragh J.F., Kotwal R. S., Cap A. P., Aden J. K., Walters T. J., Kheirabadi B. S. et al. Performance of Junctional Tourniquets in Normal Human Volunteers // Prehosp. Emerg. Care. 2015. Vol. 19, No 3. P. 391–398.
19. Kheirabadi B.S., Terrazas I. B., Miranda N., Voelker A. N., Grimm R., Kragh J. F. et al. Physiological Consequences of Abdominal Aortic and Junctional Tourniquet (AAJT) Application to Control Hemorrhage in a Swine Model // Shock. 2016. Vol. 46, No 3. P. 160–166.
20. Kragh J.F., Lunati M. P., Kharod C. U., Cunningham C. W., Bailey J. F., Stockinger Z. T. et al. Assessment of Groin Application of Junctional Tourniquets in a Manikin Model // Prehosp Disaster Med. 2016. Vol. 31, No 4. P. 358–363.
21. Meusnier J.G., Dewar C. Mavrovi E., Caremil F., Wey P. F., Martinez J. Y. Evaluation of Two Junctional Tourniquets Used on the Battlefield: Combat Ready Clamp® versus SAM® Junctional Tourniquet // J. Spec. Oper. Med. 2016. Vol. 16, No 3. P. 41–46.
22. Chen J., Benov A., Nadler R., Landau G., Sorkin A., Aden J. et al. Testing of Junctional Tourniquets by Medics of the Israeli Defense Force in Control of Simulated Groin Hemorrhage // J. Spec. Oper. Med. 2016. Vol. 16, No 1. P. 36–42.
23. Theodoridis C.A., Kafka K. E., Perez A. M., Curlee J. B. Yperman P. C.J., Opperman N. et al. Evaluation and Testing of Junctional Tourniquets by Special Operation Forces Personnel: A Comparison of the Combat Ready Clamp and the Junctional Emergency Treatment Tool // J. Spec. Oper. Med. 2016. Vol. 16, No 1. P. 44–50.
24. Kragh J. F. Jr., Aden J. K. Rd., Shackelford S., Moore V. K. 3rd, Dubick M. A. Assessment of Trainer Skill to Control Groin-Wound Bleeding: Use of Junctional Tourniquet Models on a Manikin // J. Spec. Oper. Med. 2017. Vol.17, No 2. P. 39–48.
25. Rall J., Cox J. M., Maddry J. The Use of the Abdominal Aortic and Junctional Tourniquet During Cardiopulmonary Resuscitation Following Traumatic Cardiac Arrest in Swine // Mil Med. 2017. Vol. 182, No 9. P. 2001–2005.
26. Rall J.M., Ross J. D., Clemens M. S., Cox J. M., Buckley T. A., Morrison J. J. Hemodynamic effects of the Abdominal Aortic and Junctional Tourniquet in a hemorrhagic swine model // J. Surg. Res. 2017. Vol. 212. P. 159–166.
27. Rall J.M., Redman T. T., Ross E. M., Morrison J. J., Maddry J. K. Comparison of zone 3 Resuscitative Endovascular Balloon Occlusion of the Aorta and the Abdominal Aortic and Junctional Tourniquet in a model of junctional hemorrhage in swine // J. Surg. Res. 2018. Vol. 226. P. 31–39.
28. Flecha I., Naylor J. F., Schauer S. G., Curtis R. A., Cunningham C. W. Combat lifesaver-trained, first-responder application of junctional tourniquets: a prospective, randomized, crossover trial // Mil. Med. Res. 2018. Vol. 5, No 1. P. 31.
29. Brännström A., Rocksén D., Hartman J., Nyman N., Gustavsson J., Arborelius U., et al. Abdominal Aortic and Junctional Tourniquet release after 240 minutes is survivable and associated with small intestine and liver ischemia after porcine class II hemorrhage // J. Trauma Acute Care Surg. 2018. Vol. 85, No 4. P. 717–724.
30. Kheirabadi B.S., Terrazas I. B., Miranda N., Voelker A. N., Klemcke H. G., Brown A. W. et al. Long-term consequences of abdominal aortic and junctional tourniquet for hemorrhage control // J. Surg. Res. 2018. Vol. 231. P. 99–108.
31. Gaspary M.J., Zarow G. J., Barry M. J., Walchak A. C., Conley S. P., Roszko P. J.D. Comparison of Three Junctional Tourniquets Using a Randomized Trial Design // Prehosp Emerg. Care. 2019. Vol. 23, No 2. P. 187–194.
32. Do W.S., Forte D. M., Sheldon R. R., Weiss J. B., Barron M. R., Sokol K. K. et al. Minimally invasive preperitoneal balloon tamponade and abdominal aortic junctional tourniquet versus open packing for pelvic fracture-associated hemorrhage: Not all extrinsic compression is equal // J. Trauma Acute Care Surg. 2019. Vol. 86, No 4. P. 625–634.
33. Croushorn J. Abdominal aortic and junctional tourniquet controls hemorrhage from a gunshot wound of the left groin // J. Spec. Oper. Med. 2014. Vol. 14, No 2. P. 6–8.
34. Kotwal R.S., Butler F. K. Tactical combat casualty care: transitioning battlefield lessons learned to other austere environments. Junctional Hemorrhage Control for Tactical Combat Casualty Care // Wilderness Environ Med. 2017. Vol. 28. P. 33–38.
35. Fisher A.D., Teeter W. A., Cordova C. B., Brenner M. L., Szczepanski M. P., Miles E. A. et al. The Role I Resuscitation Team and Resuscitative Endovascular Balloon Occlusion of the Aorta // J. Spec. Oper. Med. 2017. Vol. 17, No 2. P. 65–73.
36. Croushorn J., Thomas G., McCord S. R. Abdominal aortic tourniquet controls junctional hemorrhage from a gunshot wound of the axilla // J. Spec. Oper. Med. 2013. Vol. 13, No 3. P. 1–4.
37. Anonymous. Abdominal aortic tourniquet? Use in Afghanistan // J. Spec. Oper. Med. 2013. Vol. 13, No 2. P. 1–2.
38. Tovmassian R.V., Kragh J. F. Jr., Dubick M. A., Baer D. G., Blackbourne L. H. Combat ready clamp medic technique // J. Spec. Oper. Med. 2012. Vol. 12, No 4. P. 72–78.
39. Gary J.L., Kumaravel M., Gates K., Burgess A. R., Routt M. L., Welch T. et al. Imaging comparison of pelvic ring disruption and injury reduction with use of the junctional emergency treatment tool for preinjury and postinjury pelvic dimensions: a cadaveric study with computed tomography // J. Spec. Oper. Med. 2014. Vol. 14, No 4. P. 30–34.
40. Klotz J.K., Leo M., Andersen B. L., Nikado A. A., Garcia G., Wichern A. M. et al. First case report of SAM(r) Junctional tourniquet use in Afghanistan to control inguinal hemorrhage on the battlefield // J. Spec. Oper. Med. 2014. Vol. 14, No 2. P. 1–5.
41. Drew B., Bennett B. L., Littlejohn L. Application of current hemorrhage control techniques for backcountry care: part one, tourniquets and hemorrhage control adjuncts // Wilderness Environ Med. 2015. Vol. 26, No 2. P. 236–245.
42. Hess J. R. Hiippala S. Optimizing the use of blood products in trauma care // Crit. Care. 2005. Vol. 9, No 5. P. 10–14.
Review
For citations:
Samokhvalov I.M., Petrov A.N., Grishin M.S., Golovko K.P. Compression devices for temporary hemostasis in injuries of the abdomen and adjacent ileo‑inguinal areas (literature review). EMERGENCY MEDICAL CARE. 2022;23(1):50-61. (In Russ.) https://doi.org/10.24884/2072-6716-2022-23-1-50-61