Page 69 - JSOM Spring 2025

The evacuation doctor accompanying the patient during trans- blood transfusion and CPR. Once resuscitated, no patient re-
port applied the AAJT-S and started CPR. ROSC was achieved quired vasopressor support. One patient died while awaiting
prior to arrival at Role 2. transport to Role 3. One patient died of wounds 10 days af-
ter wounding. Four patients survived to discharge. Three of
After arrival to Role 2a, AAJT-S was removed (application these were followed and found to be neurologically intact. The
time 30 minutes), and REBOA was initiated. The abdominal fourth patient was lost to follow-up, but no record of death
cavity was packed, chest seals applied, and a chest thoracos- matched his name and date of birth at 18 months.
tomy was performed. Component blood products and blood
plasma were transfused.
Discussion
DCS was performed at Role 2b with partial liver resection and The introduction of field stabilization points and the com-
injured bowel resection. He was alive at the time of transfer mencement of DCS near the frontline in the first month of
to the Role 3 facility. An effort was made to check the status the war reduced observed mortality (unpublished observa-
of the patient, and no record of death exists at 18 months tions). We believe that life-saving interventions (such as the
post-wounding. AAJT-S to stop bleeding at Role 1) in conjunction with lyo-
philized plasma and blood transfusion by the Combat Medic
Patient 6 at the point of wounding and during evacuation are effective.
Patient 6 sustained injuries after stepping on a landmine. He We provide simple immediate DCS at Role 2a and full DCS
incurred a traumatic above-the-knee amputation of the left leg at Role 2b. The early administration of blood products and
at the level of the lower 1/3 of the thigh, multiple wounds of whole blood and the use of blood-warming technology have
the right thigh and lower leg, and damage to the deep femoral been instrumental in improving outcomes.
artery of the right thigh. He also sustained a gunshot wound
to the pelvis with extensive destruction of the pelvic bones as These cases and experiences throughout Ukraine, where air
well as damage to the intestines and bladder. evacuation is not possible, illustrate the challenges and neces-
sity of using this approach to patient management. Six out
The combat medic reached the casualty 30 minutes after of six cases of TCA were successfully resuscitated with the
wounding. Extremity tourniquets were applied to both thighs. AAJT-S. At the forward surgical stabilization site, TCA from
On arrival at Role 2a, the patient was unstable with a sys- hemorrhage is an especially challenging issue. Traditional tho-
tolic pressure of 60mmHg. Shortly after arrival, he went into racotomy with aortic clamping comes with consequences best
cardiac arrest. The AAJT-S was applied, cardiopulmonary managed in a large, well-lit, and resourced hospital, not in a
resuscitation was initiated, and four units of plasma and 2L field environment. Published data and our experience with the
of lactated Ringers were infused. The patient had a return of device show no complications when applied for less than 2
spontaneous circulation. A pelvic splint was applied. The pa- hours at this location. 9
tient stabilized, and no vasopressors were required.
Animal studies conducted in 2017 by the U.S. Air Force 59th
Unfortunately, due to effective artillery fire focused on the hos- Medical Wing demonstrated 83% ROSC after 3 minutes of
pital, the evacuation of this wounded man could not be carried asystole following hemorrhagic shock. In their study, the
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out. He died of wounds 3 hours and 10 minutes after arriving AAJT-S was applied, blood was transfused, and CPR was
at the Role 2 facility while awaiting evacuation transport. performed. This study had a clear, direct application to the
problem of TCA in casualties at the forward surgical stabili-
zation point in Ukraine. Therefore, we believed we could ap-
ply the device, initiate blood transfusion, and begin CPR in
patients with limited asystolic times. Further human data on
the use of the AAJT-S with TCA patients has demonstrated the
effectiveness of the AAJT-S for this use. 5

FIGURE 2 The TCA has an extremely low rate of success, with only one in 20
abdominal aortic surviving and only 40% of survivors with a favorable neuro-
and junctional logical outcome. This case series examines the utility of this
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tourniquet – novel truncal tourniquet in TCA, particularly on the modern
stabilized (AAJT-S)
applied to traumatic battlefield where air superiority is non-existent and there are
cardiac arrest prolonged evacuation times. Medical care in war cannot re-
(TCA) patient. main static, and we must always innovate and advance. The
use of the AAJT-S in cases of TCA has allowed the control of
hemorrhage, the benefits of increased mean arterial pressure,
and the ability to focus the effects of resuscitative interven-
tions on the upper torso.

The administration of blood and CPR has also provided
focused benefits to the organs above the level of applica-
tion. This ensured that resuscitative efforts went imme-
Results
diately and preferentially to the heart, lungs, kidney, and
All six patients in TCA due to hypovolemic shock were suc- brain. The device performs the same physiological function
cessfully resuscitated using the AAJT-S in combination with as Zone 3 REBOA at the abdominal application site over

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