Testing of Junctional Tourniquets by Military Medics to Control Simulated Groin Hemorrhage

Kragh, John F; Parsons, Donald L; Kheirabadi, Bijan S.; Aden, James K; Gerhardt, Robert T.; Baer, David G.; Dubick, Michael A.

doi:10.55460/jad6-ps0c

Cited by 35 publications

(12 citation statements)

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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%

“…Each JTQ had an application time of: CRoC 68-128 s [19,[21][22][23]25], JETT 10-203 s [19,21,23,25], SJT 34-80 s [19,[21][22][23], and AAJT 98-171 s [16,19,21]. Of the studies which assessed the safety of the JTQs (n = 7), none reported any incidences of adverse events [18,21,22]. User surveys reported the SJT to be the most preferred of the JTQs.…”

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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“…Kragh et al (2014) 8 : A study of military medic use of junctional tourniquets in simulated prehospital trauma care. Nine medics used 4 different junctional tourniquets (CRoC, AAJT, JETT, and SJT).…”

Section: Studies Comparing the 4 Junctional Tourniquetsmentioning

confidence: 99%

“…14,15 One study evaluated the physiologic consequences of AAJT application to control hemorrhage in a swine model. 16 This study looked at the physiologic effects of 7 Time to stop bleeding X Blood loss volume X Kragh et al 8 Effectiveness X X Time to effectiveness X X Medic ranking X X Kragh et al 9 Effectiveness X X X Time to effectiveness X X Pain X X X Subject rating X Chen et al 10 Effectiveness X X Time to effectiveness X X Medic ranking X X…”

Section: Aajtmentioning

confidence: 99%

Junctional Hemorrhage Control for Tactical Combat Casualty Care

Kotwal

Butler

2017

Wilderness & Environmental Medicine

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During historic, as well as more recent, conflicts, most combat casualties who die from their injuries do so in the prehospital setting. Although many of the injuries incurred by these casualties are nonsurvivable, a number of injuries are still potentially survivable. Of those injuries that are potentially survivable, the majority are truncal, junctional, and extremity hemorrhage. Novel and effective approaches directed toward prehospital hemorrhage control have emerged in recent years, some of which can prove useful in the management of junctional hemorrhage whether in a military or civilian setting. An initial comprehensive review of junctional tourniquets was conducted by the Department of Defense Committee on Tactical Combat Casualty Care in 2013. The objective of this article is to provide an updated review of junctional hemorrhage control efforts and devices as they apply primarily to military prehospital trauma management and Tactical Combat Casualty Care and to prompt further consideration and application of these devices in nonmilitary prehospital, austere, and wilderness environments. Four junctional tourniquets are currently cleared by the Food and Drug Administration (FDA) for junctional hemorrhage control, and 1 junctional tourniquet is also FDA-cleared for pelvic stabilization. As junctional hemorrhage control efforts progress, scientists need to continue to conduct research and clinicians need to continue to monitor the performance of junctional tourniquets, especially in conjunction with morbidity and mortality outcomes, for both military and civilian trauma patients.

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Massive Haemorrhage Control

Yaqub

Lax

2022

Textbook of Acute Trauma Care

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Testing of Junctional Tourniquets by Military Medics to Control Simulated Groin Hemorrhage

Cited by 35 publications

References 0 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

Junctional Hemorrhage Control for Tactical Combat Casualty Care

Massive Haemorrhage Control

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