Page 101 - JSOM Summer 2018

In a second method, the Abdominal Aortic and Junctional Each of these three novel methods for obtaining temporary
Tourniquet (AAJT ; Compression Works LLC, Birmingham, hemorrhage control in NCTH uses a unique approach. Their
™
AL) (Figure 2) is applied to the mid-abdomen of a patient. potential applicability has never been openly evaluated and
A pneumatic bladder is then inflated, putting pressure on the compared in the context of a cohort of real trauma patients.
aortic bifurcation, until distal pulses are no longer felt. This How many trauma patients may benefit from the use of each
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device requires minimal training, can be placed by nonmedical device has not been definitively established and remains theo-
personnel, and was designed for field application. retical. The goals of this work were to assess what percentage
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of patients with NCTH, who lived long enough to receive a
FIGURE 2 The Abdominal Aortic and Junctional Tourniquet trauma laparotomy, could have potentially been benefited by
(AAJT; Compression Works LLC, Birmingham, AL; the use of one of these three interventions and to determine
https://compressionworks.com). which method had the greatest potential applicability. It was
hypothesized that REBOA would have the greatest potential
benefit within the NCTH trauma population.

Methods
This was a single-center (Memorial Hermann Hospital, Hous-
ton, TX) retrospective study using Trauma Registry data of
injured patients who went directly from the ED to the OR for
a laparotomy between 1 January 2013 and 1 January 2015.
The operative notes were individually reviewed by one of the
authors (JBH) to determine the location(s) of injury identified
during surgery. For each patient, each temporary hemorrhage
control method underwent a binary categorization of being
potentially beneficial or not potentially beneficial for preoper-
ative hemorrhage control based on the intraoperative findings.
Image courtesy of Dr John Croushorn and Dr Richard Schwartz (per- The potential benefit of each temporary hemorrhage control
sonal communication).
technique in patients with the most substantial physiologic
A third method is the use of self-expanding intracavitary foam derangement, defined as those who required transfusion of 3
(ResQFoam ; Arsenal Medical, Inc., Watertown, MA) (Fig- or more units of red blood cells (RBCs), was evaluated as a
TM
ure 3). In this system, two liquids, percutaneously injected subgroup.
into the abdomen via a syringe-like injector, create a foam that
expands throughout the peritoneal cavity, leading to a direct Given the unique method used by each form of temporary
tamponade of hemorrhage. At the receiving center, patients hemorrhage control, the criteria used to determine if a patient
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require a laparotomy for definitive hemorrhage control and could have potentially benefited from their implementation
foam removal. This method is still under development and is were different. REBOA was classified as potentially beneficial
now cleared by the US Food and Drug Administration (FDA) if vascular injuries were located below the diaphragm; no inju-
to start a prospective human study. ries were noted above the diaphragm, including injuries to the

FIGURE 3 A rendition of ResQFoam self-expanding intracavitary foam in use. (a) Injection of two liquids percutaneously into the abdominal
cavity via a syringe-like injector. (b) Expansion of resulting foam throughout the abdominal cavity. (c) Foam cast removed at time of
laparotomy. (d-g) In vitro example of foam expansion.

Image courtesy of Arsenal Medical, Inc., Watertown, MA (http://arsenalmedical.com) and adapted from Rago et al. 24

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