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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
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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 

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