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

Rall, Jason M.; Redman, Theodore T.; Ross, Elliot; Morrison, Jonathan J.; Maddry, Joseph K.

doi:10.1016/j.jss.2017.12.039

Cited by 21 publications

(9 citation statements)

References 32 publications

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“…This is an advantage over other point-of-injury devices, such as abdominal aortic junctional tourniquet, which is designed to create a zone 3 occlusion and has only been compared with REBOA for such. [24][25][26] While there were no significant differences in survival between the REBOA and GROA groups, it is important to note that both devices were preplaced prior to hemorrhage. The GROA device is envisioned to be placed similar to an orogastric tube.…”

Section: Discussionmentioning

confidence: 99%

Gastroesophageal resuscitative occlusion of the aorta prolongs survival in a lethal liver laceration model

McCracken

Tiba²,

Mahmood³

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND: Noncompressible torso hemorrhage management remains a challenge especially in the prehospital setting. We evaluated a device designed to occlude the aorta from the stomach (gastroesophageal resuscitative occlusion of the aorta [GROA]) for its ability to stop hemorrhage and improve survival in a swine model of lethal liver laceration and compared its performance to resuscitative endovascular balloon occlusion of the aorta (REBOA) and controls. METHODS:Swine (n = 24) were surgically instrumented and a 30% controlled arterial hemorrhage over 20 minutes was followed by liver laceration. Animals received either GROA, REBOA, or control (no treatment) for 60 minutes. Following intervention, devices were deactivated, and animals received whole blood and crystalloid resuscitation. Animals were monitored for an additional 4 hours. RESULTS:The liver laceration resulted in the onset of class IV shock. Mean arterial blood pressure (MAP) (standard deviation) decreased from 84.5 mm Hg (11.69 mm Hg) to 27.1 mm Hg (5.65 mm Hg) at the start of the intervention. Seven of eight control animals died from injury prior to the end of the intervention period with a median survival (interquartile) time of 10.5 minutes (12 minutes). All GROA and REBOA animals survived the duration of the intervention period (60 minutes) with median survival times of 86 minutes (232 minutes) and 79 minutes (199 minutes) after resuscitation, respectively. The GROA and REBOA animals experienced a significant improvement in survival compared with controls ( p = 0.01). Resuscitative endovascular balloon occlusion of the aorta resulted in higher MAP at the end of intervention 114.6 mm Hg (22.9 mm Hg) compared with GROA 88.2 mm Hg (18.72 mm Hg) ( p = 0.024), as well as increased lactate compared with GROA 13.2 meq•L −1 (1.56 meq•L −1 ) versus 10.5 meq•L −1 (1.89 meq•L −1 ) ( p = 0.028). Histological examination of the gastric mucosa in surviving animals revealed mild ischemic injury from both GROA and REBOA. CONCLUSION: The GROA and REBOA devices were both effective at temporarily stanching lethal noncompressible torso hemorrhage of the abdomen and prolonging survival.

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Section: Discussionmentioning

confidence: 99%

Gastroesophageal resuscitative occlusion of the aorta prolongs survival in a lethal liver laceration model

McCracken

Tiba²,

Mahmood³

et al. 2021

J Trauma Acute Care Surg

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“…There are of course invasive methods of arresting ‘non-compressible’ haemorrhage such as resuscitative endovascular balloon occlusion of the aorta (REBOA),19 20 but this is not a CMT-delivered intervention 5 6 21. The American College of Surgeons Committee on Trauma and the American College of Emergency Physicians state that REBOA should only be deployed when an acute care surgeon is immediately available 21.…”

Section: Discussionmentioning

confidence: 99%

Abdominal Aortic Junctional Tourniquet - Stabilized (AAJTS) can be applied both successfully and rapidly by Combat Medical Technicians (CMTs)

Smith¹,

Beaven

Handford

et al. 2021

BMJ Mil Health

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Background‘Non-compressible’ haemorrhage is the leading cause of preventable battlefield death, often requiring surgical or radiological intervention, which is precluded in the pre-hospital environment. One-fifth of such bleeds are junctional and therefore potentially survivable. We examine the use of the Abdominal Aortic Junctional Tourniquet - Stabilized (AAJTS) among UK Combat Medical Technicians (CMTs) as a device to control junctional haemorrhage with external compression of the abdominal aorta—compression of junctional haemorrhage previously considered ‘non-compressible.’ This follows animal studies showing that the AAJTS achieves control of haemorrhage and improves physiological parameters.MethodsCMTs were selected and applied the AAJTS to each other following a 1-hour training package. A consultant radiologist-operated hand-held ultrasound monitored flow changes in the subjects’ common femoral artery. CMTs were then surveyed for their opinions as to utility and function.Results21 CMTs were screened and 17 CMTs participated with 34 total applications (16 day and 18 low-light). 27/34 (79%) achieved a successful application. The median application time was 75 s in daylight and 57 s in low-light conditions. There was no significant difference in Body Mass Index (p=0.23), median systolic blood pressure (p=0.19), nor class of CMT (p=0.10) between successful and unsuccessful applications. Higher systolic blood pressure was associated with longer application times (p=0.03). Users deemed the device easy to use (median score 4.4 on a 5-point Likert scale).ConclusionCMTs can use AAJTS successfully after a 1-hour training session in the majority of applications. Application was successful in both daylight and low-light conditions. Self-reported usability ratings were high.

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“…Whilst the AAJT has potential physiological consequences of prolonged application, it can be applied rapidly and would rarely delay transport to a trauma centre, whilst delivering equivalent aortic occlusion to zone 3 REBOA with a similar physiological profile. 5 Brannstrom and colleagues demonstrated that transition from AAJT to zone 3 REBOA is possible, 17 and adoption of both strategies would enable pre-hospital teams to minimise scene and transport time by applying the AAJT, with trauma centres transitioning to REBOA in ED or the OT. In our system the use of prehospital REBOA should also be explored but the greatest benefit is likely to arise from decreasing the time to intervention in exsanguinating patients by adopting more effective, evidence-based dispatch strategies.…”

Section: Discussionmentioning

confidence: 99%

“…3 The Abdominal Aortic and Junctional Tourniquet (AAJT) (Compression Works LLC, Birmingham, AL, United States) provides external aortic compression. It is a belt-like device with an inflatable bladder that when applied to the abdomen at the level of the umbilicus delivers sufficient external pressure to the distal aorta to cease flow through the femoral arteries, 4 requires minimal training, takes 60À90 s to apply, 5 and has been shown in animal models to increase systemic vascular resistance, Mean Arterial Pressure (MAP), carotid blood flow, and increase the rate of return of spontaneous circulation (ROSC) in hypovolaemic TCA. 6À8 There is only one previously reported case of use of the AAJT in TCA; a pulseless combat casualty in Afghanistan with return of palpable pulse and increase in end tidal carbon dioxide (etCO 2 ) in the setting of lower limb exsanguination 9 .…”

Section: Introductionmentioning

confidence: 99%

First experience with the abdominal aortic and junctional tourniquet in prehospital traumatic cardiac arrest

et al. 2020

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Introduction: The Abdominal Aortic and Junctional Tourniquet (AAJT) increased systemic vascular resistance, mean arterial pressure, carotid blood flow and rate of return of spontaneous circulation (ROSC) in animals with hypovolaemic traumatic cardiac arrest (TCA). The objective of this study was to report the first experience of the use of the AAJT as part of a pre-hospital TCA algorithm.Methods: This is a descriptive case series of the use of the AAJT in patients with TCA in a civilian physician-led pre-hospital trauma service in Sydney, Australia between June 2015 to August 2019. Cases were identified and data sourced from routinely collected data sets within the retrieval service.Results: During the study, 44 TCAs were attended, 22 with AAJT application. Mean time (standard deviation) to AAJT application since last signs of life was 16 (9) min. Eighteen (16 males, 2 females) patients, with median age (interquartile range) of 40 (25À58) years, were included for analysis.Seventeen patients (94%) had blunt trauma. Sixteen patients (89%) were in TCA at the time of service contact, 11 (61%) had a change in electrical activity, 4 (22%) had ROSC, and of the 6 with documented end-tidal carbon dioxide, the mean rise was 24.0 mmHg (95% CI 12.6À35.4) (P = 0.003).Three patients (17%) had sustained ROSC on arrival to the Emergency Department. No patients survived to hospital discharge. Conclusion:Physiological changes were demonstrated but there were no survivors. Further research focusing on faster application times may be associated with improved outcomes.

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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

Cited by 21 publications

References 32 publications

Gastroesophageal resuscitative occlusion of the aorta prolongs survival in a lethal liver laceration model

Gastroesophageal resuscitative occlusion of the aorta prolongs survival in a lethal liver laceration model

Abdominal Aortic Junctional Tourniquet - Stabilized (AAJTS) can be applied both successfully and rapidly by Combat Medical Technicians (CMTs)

First experience with the abdominal aortic and junctional tourniquet in prehospital traumatic cardiac arrest

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