Page 45 - JSOM Fall 2018

of the patients in the published case series were also reported to contributed to the background/literature search. BLB and DJ
the iTraumaCare postmarket surveillance spontaneous report­ contributed to the study design and revised the manuscript. SL
ing database). Environment of application ranges from use in revised the manuscript and JBH contributed to the study de­
the emergency department by trauma surgeons 24,25 to prehos­ sign, revised the manuscript, and critically reviewed the manu­
pital nonmedical users with much less experience. The two script. All authors approved the final version of the manuscript.
34
largest case series were both prehospital (24 cases treated by
paramedics and 10 cases treated by physicians ), and effec­ References
18
19
tive hemorrhage control was achieved in approximately 90% 1. Kauvar DS, Lefering R, Wade CE. Impact of hemorrhage on
of cases and failure rates were in the 5% to 10% range. trauma outcome: an overview of epidemiology, clinical presenta­
tions, and therapeutic considerations. J Trauma. 2006;60(6 suppl):
S3–11.
Although all the articles talk about the effectiveness and the 2. Singer AJ, Thode HC Jr, Hollander JE. National trends in ED
ease of use of the iTClamp, the conclusions are based on lim­ lacerations between 1992 and 2002. Am J Emerg Med. 2006;24
ited data from few patients. Limitations for this study include (2):183–188.
the retrospective nature of the review and the inherently bi­ 3. Sacks JJ, Kresnow M, Houston B. Dog bites: how big a problem?
ased nature of voluntary self­report. However, because human Inj Prev. 1996;2(1):52–54.
nature dictates that people are more likely to complain than 4. Malone ML, Rozario N, Gavinski M, et al. The epidemiology
applaud, 35,36 it is likely that this sample is capturing the nega­ of skin tears in the institutionalized elderly. J Am Geriatr Soc.
1991;39(6):591–595.
tive instance of the iTClamp use, which is important when dis­ 5. Brookes M, MacMillan R, Cully S, et al. Head injuries in accident
cussing hemorrhage control. Nevertheless, because this report and emergency departments. How different are children from
is still only level IV therapeutic evidence; additional prospec­ adults? J Epidemiol Community Health. 1990;44(2):147–151.
tive studies are warranted. 6. Turnage B, Maull KI. Scalp laceration: an obvious ‘occult’ cause
of shock. South Med J. 2000;93(3):265–256.
One area of research could involve why reapplication of the 7. Basyuni S, Panayi A, Sharma V, et al. A missed scalp laceration
causing avoidable sequelae. Int J Surg Case Rep. 2016;23:61–64.
iTClamp is not attempted when hemorrhage control is not 8. Lemos MJ, Clark DE. Scalp lacerations resulting in hemorrhagic
obtained initially with the iTClamp. During training, first shock: case reports and recommended management. J Emerg
responders are taught to reapply the iTClamp if hemorrhage Med. 1988;6(5):377–379.
control is not successful on the first try. However, from this 9. Tisherman SA, Bokhari F, Collier B, et al. Clinical practice guideline:
case series, in 50% (n = 10) of the cases where hemorrhage penetrating zone II neck trauma. J Trauma. 2008;64(5):1392–1405.
control was reported as inadequate, reapplication was not 10. McConnell DB, Trunkey DD. Management of penetrating trauma
to the neck. Adv Surg. 1994;27:97–127.
attempted. This information could help determine the mech­ 11. Wandling MW, Nathens AB, Shapiro MB, et al. Association
anisms of injury and wound locations that are less amenable of Prehospital mode of transport with mortality in penetrating
to iTClamp application, because the first responders decided trauma: a trauma system­level assessment of private vehicle trans­
to immediately go to another modality of hemorrhage control. portation vs ground emergency medical services. JAMA Surg.
The information also perhaps could tease out further the hem­ 2018;153(2):107–113.
orrhage control success rate, if reapplication results in the bleed­ 12. Thompson L. Application of the iTClamp in the management of hae­
morrhage: a case study. J Paramedic Practice. 2014;6(5):228–230.
ing being controlled. 13. Filips D, Mottet K, Lakshminarasimhan P, et al. The iTClamp 50,
a hemorrhage control solution for care under fire. ICMM World
Conclusion Congress on Military Medicine. 2014.
14. Filips D, Logsetty S, Tan J, et al. The iTClamp controls junctional
This review of 245 reported cases adds to the body of knowl­ bleeding in a lethal swine exsanguination model. Prehosp Emerg
edge on the safety and effectiveness of the iTClamp in the Care. 2013;17(4):526–532.
clinical setting. Additional studies are warranted; however, the 15. Mottet K, Filips D, Logsetty S, et al. Evaluation of the iTClamp
iTClamp appears to be a safe and effective device for the use in 50 in a human cadaver model of severe compressible bleeding. J
Trauma Acute Care Surg. 2014;76(3):791–797.
hemorrhage control, particularly as an adjunct or in conjunc­ 16. Mckee JRD, Mckee I, Kirkpatrick A. iTClamp application for
tion with other accepted devices. control of simulated massive upper extremity arterial hemorrhage
by tactical police. Can J Surg. 2015;58(2):S31–S32.
™
Disclosures 17. Hudson A, Glazebrook W. First UK use of the iTClamp haemor­
Ms Mckee reports personal fees from Innovative Trauma rhage control system: case report. Trauma. 2014;16(3):214–216.
Care, during the conduct of the study; personal fees from 18. Tan EC, Peters JH, Mckee JL, et al. The iTClamp in the manage­
ment of prehospital haemorrhage. Injury. 2016;47(5):1012–1015.
Aceso, grants from Canadian Forces, outside the submitted 19. Shaw G, Thompson L, Davies C. A service evaluation of the iT­
work; and that Dr Kirkpatrick is her partner. Dr Kirkpatrick Clamp50 in pre­hospital external haemorrhage control. British
reports other from Innovative Trauma Care, during the con­ Paramedic J. 2016;1(2):30–34.
duct of the study; personal fees from Innovative Trauma Care, 20. Barnung S, Steinmetz J. A prehospital use of ITClamp for haemo­
personal fees from Acelity, personal fees from Cook Medical, static control and fixation of a chest tube. Acta Anaesthesiol
Scand. 2014;58(2):251–3.
outside the submitted work; and that he has a personal rela­ 21. Kirkpatrick AW, Mckee JL. Tactical hemorrhage control case
tionship with Ms Mckee, who is his partner. D. Logsetty re­ studies using a point­of­care mechanical direct pressure device. J
ports other from Innovative Trauma Care, during the conduct Spec Oper Med. 2014;14(4):7–10.
of the study. Drs Bennett and Jenkins have nothing to disclose. 22. Kirkpatrick AW, Mckee JL, Mckee I, et al. Remote telementored
ultrasound­directed compression to potentially accelerate hemo­
Author Contributions stasis in exsanguinating junctional vascular injuries. J Spec Oper
JM contributed to the study design, drafted and revised the Med. 2015;15(4):71–74.
manuscript, led the analysis, and contributed to the back­ 23. St John AE, Wang X, Lim EB, et al. Effects of rapid wound sealing
on survival and blood loss in a swine model of lethal junctional
ground/literature search. AWK contributed to the study design, arterial hemorrhage. J Trauma Acute Care Surg. 2015;79(2):
revised the manuscript, critically reviewed the manu script, and 256–262.

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