Comparison of Three Junctional Tourniquets Using a Randomized Trial Design

Gaspary, Micah J; Zarow, Gregory J.; Barry, Michael J.; Walchak, Alexandra C; Conley, Sean P.; Roszko, Paul J D

doi:10.1080/10903127.2018.1484968

Cited by 18 publications

(16 citation statements)

References 19 publications

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“…Of the 14 studies included for JTQ review, eight were conducted in 194 healthy human volunteers [16][17][18][19][20][21][22][23] (Table 2), 3 were conducted on 16 perfused human cadavers [24][25][26] (Table 3), and 2 case series [27,28] and 1 case report [29] on 21 trauma patients (Table 4). The total number of cadavers and volunteers was 210.…”

Section: Pre-hospital Feasability Evidencementioning

confidence: 99%

“…Device efficacy was reported in all 11 studies involving cadavers or volunteers and ranged from 11-100% across all four JTQs. The efficacy of the CRoC ranged from 84-100% [18,19,[21][22][23][24][25]; the AAJT ranged from 11-100% [16][17][18][19][20][21]; JETT had an efficacy range from 75-100% [18,19,21,23,25], and the SJT ranged from 82-100% [18,19,[21][22][23]26]. Only one study assessed the efficacy of the SJT, JETT, and CRoC during the transport in volunteers, ranging from 24-48%.…”

Section: Pre-hospital Feasability Evidencementioning

confidence: 99%

“…Only one study assessed the efficacy of the SJT, JETT, and CRoC during the transport in volunteers, ranging from 24-48%. The SJT was reported to have a significantly higher transport efficacy (48%) than the JETT (24%; p = 0.03) [23]. Application time was recorded in 6 of the JTQ feasibility studies [16,19,[21][22][23]25] and ranged from 10-203 s overall.…”

Section: Pre-hospital Feasability Evidencementioning

confidence: 99%

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Use of Haemostatic Devices for the Control of Junctional and Abdominal Traumatic Haemorrhage: A Systematic Review

2022

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Catastrophic haemorrhage accounts for up to 40% of global trauma related mortality and is the leading cause of preventable deaths on the battlefield. Controlling abdominal and junctional haemorrhage is challenging, especially in the pre-hospital setting or ‘under fire’, yet there is no haemostatic agent which satisfies the seven characteristics of an ‘ideal haemostat’. We conducted a systematic search of Embase, Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science to evaluate the feasibility and efficacy of three types of haemostatic devices. Participants included any trauma patient in a pre-hospital setting, perfused human cadavers, or healthy human volunteer simulations. The haemostatic devices reviewed were REBOA, iTClampTM, and four junctional tourniquets: AAJT, CRoC, JETT, and SJT. The SJT had the best user survey performance of the junctional tourniquets, and the four junctional tourniquets had an overall efficacy of 26.6–100% and an application time of 10–203 s. The iTClampTM had an efficacy of 60–100% and an application time of 10–60 s. REBOA had an efficacy of 71–100% and an application time ranging from 5 min to >80 min. In civilian and military trauma patients the use of junctional tourniquets, iTClamp, or REBOA, mortality varied from 0–100%. All of these studies were deemed low to very low in quality, hence the reliability of data presented in each of the studies is called into question. We conclude that despite limited data for these devices, their use in the pre-hospital environment or ‘under fire’ is feasible with the correct training, portable imaging, and patient selection algorithms. However, higher quality studies are required to confirm the true efficacy of these devices.

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Section: Pre-hospital Feasability Evidencementioning

confidence: 99%

Section: Pre-hospital Feasability Evidencementioning

confidence: 99%

Section: Pre-hospital Feasability Evidencementioning

confidence: 99%

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Use of Haemostatic Devices for the Control of Junctional and Abdominal Traumatic Haemorrhage: A Systematic Review

2022

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“…In recent years, several cases reported applying new hemostatic devices, such as AAJT TM CRoC TM JETT TM SAM-JT TM , among patients with junctional hemorrhage in the prehospital settings [5][6][7][8] . However, the effectiveness was only at 24 48% [9] in the pre-hospital and the transport process. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is an emerging strategy for junctional hemostasis and has been applied in the pre-hospital settings.…”

Section: Introductionmentioning

confidence: 96%

Resuscitative Endovascular Balloon Occlusion of the Aorta（REBOA） in A Swine Model of Iliac Artery Hemorrhage under the Guidance of Portable Ultrasound

Huang

Shan²,

Wu³

et al. 2021

Preprint

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Background: The major challenge of applying Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in the pre-hospital setting is to accurately place the balloon in. To evaluate the effects of applying portable ultrasound to guide REBOA for iliac artery hemostasis.Methods: We first established a swine model of hemorrhage by percutaneously puncture the right iliac artery under the guidance of portable ultrasound. Then we randomly divided the swine into two groups. We recorded systolic pressure (SP), diastolic pressure (DP), heart rate (HR), and the maximum depth of the ascites at baseline (T1), free bleeding for the 30s (T2), bleeding for 10min (T3), and bleeding for 30min (T4). Immediately after T2, we performed REBOA under the guidance of portable ultrasound in the intervention group and manual extracorporeal compression by dry gauze in the control group. We collected total blood loss at T4.Results: There were 11 swine included in the analysis (intervention group=6, control group=5). The characteristics of the two groups were similar at T1. After punctured the right iliac artery, hemorrhagic shock appeared in both groups at T2 - BP and DP fell, HR elevated, and the maximum depth of the ascites increased. After performing REBOA, SP(in mmHg) in the intervention group significantly increased to 97.17±11.92 at T3 and remained stable throughout T4; while SP in the control group kept decreasing and reached 62.40±3.44 at T4. A similar trend was found in DP. HR(in bpm) in the intervention group increased from 101.50±5.39 in T2 to 111.83±7.39 in T3 and stabilized at 113.83±5.49 in T4; in the control group, it kept increasing from 103.20±3.70 in T2 to 132.40±3.98 in T4. The maximum depth of the ascites increased between T2 and T4 in both groups, but significantly slower in the intervention group (at T4 3.50±0.36cm vs 5.14±0.35cm, P<0.05). The total blood loss was significantly less in the intervention group (1245.23±190.07g) than in the control group (2605.63±291.67g).Conclusions: Performing REBOA under the guidance of portable ultrasound can improve the effectiveness of iliac artery hemostasis and have great potential to save lives in pre-hospital settings.

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“…The emergence of EHCDs, such as combat ready clamp (CRoC), abdominal aortic and junctional tourniquet (AAJT) and SAM junctional tourniquet (SJT), has changed the dilemma of ineffective control of NCTH within battle elds or extreme environments, providing the possibility for further reducing the rate of killed in action (KIA) (6,7). However, too broad of a pressurized area and ambiguous vascular locating methods are ubiquitous among existing EHCDs, often resulting in excessive peripheral tissue/organ compression or high compression segments of targeted arteries.…”

mentioning

confidence: 99%

Imaging Anatomy and Surface Localization of External Control Device - Target ed Arteries for Noncompressible Torso Hemorrhage

zhang

liu

et al. 2020

Preprint

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Background: Noncompressible torso hemorrhage (NCTH) is the main cause of prehospital death due to war injury. External hemorrhage control devices (EHCDs) are effective in reducing the death risk of NCTH, but the pressurized area is too large to prevent serious organ damage. This study aims to establish the surface localization strategy of EHCDs based on anatomical features of NCTH-related arteries through human CT images to facilitate the optimal design and application of EHCDs and eventually reduce relevant injuries. Methods: Images of 200 patients aged 18-65 years who underwent abdominal contrast-enhanced CT scans were collected. Anatomical parameters such as the length and diameter of the aortic bifurcation (AB), common iliac artery (CIA), external iliac artery (EIA) and common femoral artery (CFA) were measured, and positional relationships among EHCD-targeted arteries, umbilicus, anterior superior iliac spine (ASIS) and pubic tubercle (PT) were determined. The accuracy of surface localization was verified by 3D-printed mannequins of 20 real patients. Results: The angle and diameter of the AB were 47.1±10.5° and 17.8±2.7 mm, respectively. The AB was 7.5±8.6 mm to the left of umbilicus. The left CIA and right EIA were longer than the contralateral CIA and right EIA (p=0.038 and p=0.000, respectively). The average length of CFA was 39.0±16.6 mm. The CIA was wider than the EIA and the CFA (p=0.000). The distance between the artery and surface decreased from the CIA to the CFA (p=0.000). The vertical distance between the CIA terminus and the ipsilateral AB-ASIS line was 19.6±8.2 mm, and the left and right perpendicular intersections were located at the upper 1/3 and 1/4 of the AB-ASIS line, respectively. The length ratio of EIA-ASIS to ASIS-PT was 0.6:1. The length of the surface location/actual subpoint-ASIS was significantly correlated (p≤0.002), and the vertical distance between the two points of the same artery was ≤ 5.5 mm. Conclusion: The arterial localization strategy established via anatomical investigation was consistent with the actual situation. The data are necessary for improving EHCD design, precise hemostasis and EHCD-related collateral injuries.

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Comparison of Three Junctional Tourniquets Using a Randomized Trial Design

Abstract: All JTQ devices performed poorly during transport. Combined, present findings highlight the potential of JTQ products for saving lives threatened by junctional wounds, but also highlight the need for specific product improvements towards fostering JTQ performance in patient transport.

Cited by 18 publications

References 19 publications

Use of Haemostatic Devices for the Control of Junctional and Abdominal Traumatic Haemorrhage: A Systematic Review

Use of Haemostatic Devices for the Control of Junctional and Abdominal Traumatic Haemorrhage: A Systematic Review

Resuscitative Endovascular Balloon Occlusion of the Aorta（REBOA） in A Swine Model of Iliac Artery Hemorrhage under the Guidance of Portable Ultrasound

Imaging Anatomy and Surface Localization of External Control Device - Target ed Arteries for Noncompressible Torso Hemorrhage

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Comparison of Three Junctional Tourniquets Using a Randomized Trial Design

Abstract: All JTQ devices performed poorly during transport. Combined, present findings highlight the potential of JTQ products for saving lives threatened by junctional wounds, but also highlight the need for specific product improvements towards fostering JTQ performance in patient transport.

Cited by 18 publications

References 19 publications

Use of Haemostatic Devices for the Control of Junctional and Abdominal Traumatic Haemorrhage: A Systematic Review

Use of Haemostatic Devices for the Control of Junctional and Abdominal Traumatic Haemorrhage: A Systematic Review

Resuscitative Endovascular Balloon Occlusion of the Aorta（REBOA） in A Swine Model of Iliac Artery Hemorrhage under the Guidance of Portable Ultrasound

Imaging Anatomy and Surface Localization&nbsp;of External Control Device - Target ed&nbsp;Arteries&nbsp;for Noncompressible Torso Hemorrhage

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Imaging Anatomy and Surface Localization of External Control Device - Target ed Arteries for Noncompressible Torso Hemorrhage