Anti-shock garment provides resuscitation and haemostasis for obstetric haemorrhage

Abstract

Objective To evaluate the feasibility, safety and effectiveness of the non-pneumatic anti-shock garment for resuscitation and haemostasis following obstetric haemorrhage resulting in severe shock. Design During a six-week period, the author served a locum tenens as the obstetrician consultant for the Memorial Christian Hospital, Sialkot, Pakistan. All women who suffered from severe obstetric haemorrhage were managed with the anti-shock garment as the first intervention. The data for this report were collected from hospital chart review. Setting Sialkot is a city of about three million and Memorial Christian Hospital is one of two major obstetric hospitals. There is no blood bank at Memorial Christian Hospital or elsewhere in Sialkot. The Memorial Christian Hospital laboratory is able to draw donor blood, type and cross match blood, and process it for transfusion 24 hours per day. Population During the six weeks of this study, in June and July 2001, there were 764 deliveries and 34 other admissions within a week following deliveries outside the hospital. Seven women with obstetric haemorrhage who developed severe shock were managed with the anti-shock garment. One woman, who was later found to have mitral stenosis, developed dyspnea upon placement of the anti-shock garment and therefore it was removed within 5 minutes. This report concerns the six women who were able to tolerate the anti-shock garment without untoward symptoms. Methods As soon as severe shock was recognised in the hospital, the anti-shock garment was placed.Crystalloid solutions were given intravenously over the first hour at a rate of 1500 mL per estimated litre of blood loss, then at a maintenance rate of 150 mL/hour. Vital signs every 15 to 30 minutes, hourly urine output and intermittent oxygen saturation were used to monitor patients during the use of the anti-shock garment. When sufficient blood transfusion had been given to restore the haemoglobin to >7 g/dL, the anti-shock garment was removed in segments at 15-minute intervals with documentation of vital signs before removal of each subsequent portion. Main outcome measures Restoration of mean arterial pressure of 70 mmHg and clearing of sensorium were considered as signs of effective resuscitation. Haemorrhage was considered controlled if the blood loss was less than 25 mL/hour. Morbidity included any complications noted in the medical chart. Results Restoration of blood pressure and improvement of mental status occurred within 5 minutes in two patients who were pulseless and three who were unconscious or confused. All patients had improvement of mean arterial pressure to greater than 70 mmHg within 5 minutes. Duration of anti-shock garment use ranged from 12 to 36 hours and none of the six women had significant further bleeding while the antishock garment was in place. Patients were comfortable during use of the anti-shock garment and no adverse effects were noted apart from a transient decrease in urine output. Conclusions The anti-shock garment rapidly restored vital signs in women wi...

CEU: Prevention and Treatment of Postpartum Hemorrhage: New Advances for Low‐Resource Settings

“…Reproduced with permission of the Royal College of Obstetricians and Gynaecologists. From Hensleigh P, 2002 56 …”

“…It also provides tamponade to bleeding sites below the level of the diaphragm and diminishes further hemorrhage. In a demonstration project, the NI‐ASG has been used for women with postpartum hemorrhage at the Memorial Christian Hospital in Sialkot, Pakistan 56,57 . This obstetric service has a delivery rate of about 8500 annually.…”

“…The outcomes of 21 patients managed with the NI‐ASG antishock garment have been reported 56,57 . These reported experiences with the NI‐ASG document rapid resuscitation from hypovolemic shock and an extended period of stabilization for patients awaiting blood transfusion and/or surgical intervention.…”

Temporary application of lower body positive pressure improves intracranial velocities in symptomatic acute carotid occlusion or tight stenosis: A pilot study

“…8,9 Accordingly, although at higher pressures, LBPP is currently routinely used in acute conditions such as obstetric hemorrhage and lower body hemorrhagic injury. 10,11 The above physiological effects likely explain the increase in cerebral blood flow velocities observed after LBPP. 12 We previously reported improved cerebrovascular blood flow velocities during LBPP in two patients with recent internal carotid artery (ICA) occlusion and cerebral hemodynamic compromise, with apparent clinical benefit and no adverse effects.…”

Nonatonic Obstetric Haemorrhage: Effectiveness of the Nonpneumatic Antishock Garment in Egypt

“…This device reverses shock by decreasing the transmural pressure and radius of the blood vessels in the lower body, thus decreasing blood flow to the abdomen and lower body and redirecting blood to the core organs. When a woman is experiencing obstetric haemorrhage, this device can restore her consciousness, pulse, and blood pressure, and it can buy her time to receive definitive therapy [6]. The NASG is relatively low cost at $170 USD per garment which can be used approximately 40 times.…”