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access to the operating room for laparotomy and damage con- 3. Davis JS, Satahoo SS, Butler FK, et al. An analysis of prehospital
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within the area of concern without a laparotomy, the second- hour.” Wilderness Environ Med. 2017;28(2):S135–S139.
ary consequences observed in this study and other methods of 5. Brosch LR, Holcomb JB, Thompson JC, et al. Establishing a hu-
man research protection program in a combatant command. J
hemorrhage control in prehospital care may be alleviated and Trauma. 2008;64(2 suppl):S9-NaN-S13.
compatible with the PFC paradigm. 6. Napolitano LM. Resuscitative endovascular balloon occlusion of
the aorta: indications, outcomes, and training. Crit Care Clin.
Limitations of this study include the absence of a group us- 2017;33(1):55–70.
ing the AAJT without plate placement. Although this would 7. Saito N, Matsumoto H, Yagi T, et al. Evaluation of the safety and
be useful knowledge to assess thrombus formation within the feasibility of resuscitative endovascular balloon occlusion of the
aorta. J Trauma Acute Care Surg. 2015;78(5):897–904.
IVC, there are still a host of other complications that occur 8. Scott DJ, Eliason JL, Villamaria C, et al. A novel fluoroscopy-free,
with external compression, making this avenue less promis- resuscitative endovascular aortic balloon occlusion system in a
ing. 12,18 Another limitation includes the length of time of ap- model of hemorrhagic shock. J Trauma Acute Care Surg. 2013;75
plication. We chose this amount of time for AAJT bladder (1):122–128.
inflation on the basis of the detrimental effects that have oc- 9. Morrison JJ, Ross JD, Markov NP, et al. The inflammatory se-
curred with prolonged aortic occlusion in other AAJT studies quelae of aortic balloon occlusion in hemorrhagic shock. J Surg
Res. 2014;191(2):423–431.
and models of aortic occlusion, such as IABO or selective aor- 10. Srikanth S, Gumbert SD, Stephens C, et al. Resuscitative endo-
tic arch perfusion. 12,20 It may be beneficial to conduct studies vascular balloon occlusion of the aorta: principles, initial clinical
to establish the appropriate length of time for occlusion that experience, and considerations for the anesthesiologist. Anesth
would produce the least amount of reperfusion injury for these Analg. 2017;125(3):884–890.
types of devices. 11. Lyon M, Shiver S, Greenfield EM, et al. Use of a novel abdominal
aortic tourniquet to reduce or eliminate flow in the common fem-
oral artery in human subjects. J Trauma Acute Care Surg. 2012;
In conclusion, in this model, the AAJT-TP did not provide any 73(2 suppl 1):S103–105.
survival benefit compared with Hextend resuscitation alone. 12. Kheirabadi BS, Terrazas IB, Miranda N, et al. Physiological
Although this study used a decreased application time for the consequences of Abdominal Aortic and Junctional Tourniquet
AAJT-TP and there was no evidence of respiratory and circu- (AAJT) application to control hemorrhage in a swine model.
latory collapse after tourniquet release, there did not appear Shock. 2016;46(3 suppl 1):160–166.
to be any improvement in the physiologic burden associated 13. Kragh JF, Kotwal RS, Cap AP, et al. Performance of junctional
with traumatic hemorrhage. Additional exploration of devices tourniquets in normal human volunteers. Prehospital Emerg
Care. 2015;19(3):391–398.
or technologies that address NCTH must be pursed to better 14. Anonymous. Abdominal aortic tourniquet use in Afghanistan. J
address this pathology in the PFC paradigm. Spec Oper Med. 2013;13(2):1–2.
15. Croushorn J, Thomas G, McCord SR. Abdominal aortic tourni-
Funding quet controls junctional hemorrhage from a gunshot wound of
This work was supported by Military Health Research Foun- the axilla. J Spec Oper Med. 2013;13(3):1–4.
dation (Grant SC-15-03, PO 0006). 16. National Research Council of the National Academies. Guide for
the Care and Use of Laboratory Animals. 8th ed. Washington,
DC: National Academies Press; 2011.
Disclosures 17. Karakose O, Fatih Benzin M, Pulat H, et al. Bogota bag use in
The authors have indicated they have no financial relation- planned re-laparotomies. Med Sci Monit. 2016;22:2900–2904.
ships relevant to this article to disclose. 18. Rall JM, Ross JD, Clemens MS, et al. Hemodynamic effects of the
Abdominal Aortic and Junctional Tourniquet in a hemorrhagic
swine model. J Surg Res. 2017;212:159–166.
Author Contributions 19. White JM, Cannon JW, Stannard A, et al. Endovascular balloon
JDR conceived the study concept and obtained funding. AMB, occlusion of the aorta is superior to resuscitative thoracotomy
HEH, TLG, BLD, LW, BHM, BMM, and JDR coordinated with aortic clamping in a porcine model of hemorrhagic shock.
and collected the data, and TLG analyzed the data. AMB Surgery. 2011;150(3):400–409.
wrote the first draft, and all authors read and approved the 20. Markov NP, Percival TJ, Morrison JJ, et al. Physiologic tolerance
final manuscript. of descending thoracic aortic balloon occlusion in a swine model
of hemorrhagic shock. Surgery. 2013;153(6):848–856.
21. Long KN, Houston R, Watson JDB, et al. Functional outcome
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