Page 51 - Journal of Special Operations Medicine - Fall 2015

Conceptualized Use of Self-Expanding Foam to
Rescue Special Operators From Abdominal Exsanguination

Percutaneous Damage Control for the Forward Deployed

Adam P. Rago, MS; Upma Sharma, PhD; Kyle Sims, BS, 18D; David R. King, MD

ABSTRACT
Background: Noncompressible hemorrhage is the leading wounds. Almost 90% of potentially survivable com-
1–4
cause of potentially survivable death on the battlefield. bat deaths occur because of inadequate hemorrhage
In Special Operations Forces (SOF), 50% of potentially control, particularly at the point of injury or en route
survivable deaths have been related to noncompressible to a surgical capability. 3,5,6 Among potentially surviv-
hemorrhage. Currently, there are no widely available able battlefield casualties, noncompressible hemorrhage
presurgical interventions that can slow abdominal bleed- from the abdomen accounts for half of all deaths. 2,3,7–10
ing. Consequently, many of the preventable deaths oc- For patients with severe abdominal injury, rapid evacu-
cur en route to definitive care as a failure to rescue from ation to surgical care offers the best chance for survival.
exsanguination. A self-expanding polyurethane foam
has been developed as a percutaneous damage control The need for far-forward hemorrhage control is perhaps
intervention to rescue casualties who would otherwise most pronounced for Special Operations warfighters;
die of noncompressible hemorrhage, and allow them in these locations, operational requirements and unique
to survive long enough to reach surgical intervention. environments complicate otherwise routine medical
The purpose of this paper is to summarize the existing challenges. Special Operations Forces (SOF) operate in
preclinical data, describe the role of SOF personnel in austere, far-forward environments, often far from orga-
foam delivery-system development, and to integrate nized surgical care. Mission requirements may prevent
these together to conceptualize how foam could be in- immediate evacuation of injured casualties and require
corporated into SOF medical care. Methods: All exist- improvised Tactical Combat Casualty Care (TCCC). A
ing publications on self-expanding foam are reviewed. review of potentially survivable deaths in SOF personnel
Additionally, eight SOF medical providers with combat by Holcomb et al. found that 50% of SOF deaths were
experience provided end-user input to delivery-device related to noncompressible hemorrhage, a rate consistent
design through an interactive human-factors testing with the military-wide Department of Defense Trauma
process. Results: Ten preclinical publications described Registry. 3,11 The failure to rescue such casualties signifies
efficacy, safety, dose translation, and risk-benefit analy- a clear and persistent capability gap for warfighters who
sis of exsanguination rescue with percutaneous-foam generally experience a lower killed-in-action and died-of-
damage control. SOF medical providers guided weight, wounds rate relative to the larger military population.
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cubic, operational requirements, and limits for the foam Thus, a significant unmet need exists for an intervention
delivery device. Conclusion: Presurgical exsanguina- that would prolong survival and enable evacuation to
tion rescue with percutaneous foam damage control is definitive surgical care for these casualties.
safe and effective with a favorable risk-benefit profile
in preclinical studies. Battlefield, presurgical use by SOF To address this capability gap, a novel, self-expanding
medical providers is conceptually possible. Adoption of polyurethane foam (ResQFoam ) engineered to treat
™
the technology on the battlefield should proceed with noncompressible abdominal hemorrhage in the presur-
SOF medical provider input. gical environment has been developed. Foam treatment
is intended as a temporary intervention (or hemostatic
Keywords: hemorrhage, noncompressible; bleeding; foam; bridge) to provide percutaneous damage control for ca-
advanced medic; abdominal; austere; ResQFoam sualties with severe abdominal hemorrhage, allowing
these casualties to be rescued from prehospital exsan-
guination and survive evacuation to a surgical capabil-
ity. The foam functions by mixing two liquid phases
Introduction
during percutaneous injection into the peritoneal cavity
Recent conflicts have exposed military personnel to using a delivery system (Figure 1). The components re-
devastating trauma from explosive devices and gunshot act in situ, creating a liquid that spreads throughout the

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