Bi-manual proximal external aortic compression after major abdominal-pelvic trauma and during ambulance transfer: A simulation study

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• 作者：M.J. Douma^a ; ^{matthew.douma@albertahealthservices.ca} ; D. O&rsquo ; Dochartaigh^b ; P.G. Brindley^c ; ^{peter.brindley@ahs.ca}
• 关键词：Noncompressible torso hemorrhage ; Junctional hemorrhage ; Prehospital care
• 刊名：Injury
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：48
• 期：1
• 页码：26-31
• 全文大小：489 K
• 卷排序：48

文摘

Applying manual pressure after hemorrhage is intuitive, cost-free, and logistically-simple. When direct abdominal-pelvic compression fails, clinicians can attempt indirect proximal-external-aortic-compression (PEAC), while expediting transfer and definitive rescue. This study quantifies the sustainability of simulated bi-manual PEAC both immediately on scene and during subsequent ambulance transfer. The goal is to understand when bi-manual PEAC might be clinically-useful, and when to prioritize compression-devices or endovascular-occlusion.MethodsWe developed a simulated central vessel compression model utilizing a digital scale and Malbrain intra-abdominal pressure monitor inside a cardiopulmonary resuscitation mannequin. Twenty prehospital health care professionals (HCPs) performed simulated bimanual PEAC i) while stationary and ii) inside an 80 km/h ambulance on a closed driving-track. Participants compressed at “the maximal effort they could maintain for 20 min”. Results were measured in mmHg applied-pressure and kilograms compressive-weight. The Borg scale of perceived-exertion was used to assess sustainability, with <16 regarded as acceptable.ResultsWhile stationary all participants could maintain 20 min of compressive pressure/weight: within five-percent of their starting effort, and with a Borg-score <16. Participants applied 88–300 mmHg compression pressure; (mean 180 mmHg), 14–55 kg compression-weight (mean 33 kg), and 37–66% of their bodyweight (mean 43%). In contrast, participants could not apply consistent or sustained compression in a moving ambulance: Borg Score exceeded 16 in all cases.ConclusionsSurvival following major abdominal-pelvic hemorrhage requires expedited operative/interventional rescue. Firstly, however, we must temporize pre-hospital exsanguination both on scene and during transfer. Despite limitations, our work suggests PEAC is feasible while waiting for, but not during, ambulance-transfer. Accordingly, we propose a chain-of-survival that cautions against over-reliance on manual PEAC, while supporting pre-hospital devices, endovascular occlusion, and expeditious but safe hospital-transfer.