Page 70 - JSOM Spring 2025

the umbilicus. It, in effect, cross-clamps the lower torso to Conclusion
stop all blood flow through the descending aorta at the level
of the aortic bifurcation and occlusion inferior vena cava Using the novel AAJT-S (along with the administration of
(IVC). whole blood and CPR) produced a 100% success rate in
achieving ROSC in our case series of six TCA patients. One
of the six patients could be followed for 12 months and was
Researchers at the Institute for Surgical Research and the U.S.
Air Force’s 59th Medical Wing have demonstrated equivalency neurologically intact then. The AAJT-S effectively manages
between AAJT-S and Zone 3 REBOA in animal models. 9,10 A massive hemorrhage and TCA on the battlefield.
Swedish animal study demonstrated a 7.2-fold increased re-
quirement for resuscitative fluids for REBOA compared to Acknowledgments
13
the AAJT-S. Published animal studies have evaluated the We would like to thank Dr. John Croushorn, who aided in
role of the AAJT-S as a bridge to reach a surgical location submitting the article and provided some minor editing. He
where REBOA could be placed. 12–13 REBOA, in the real world, was not involved with study design or data collection and
cannot be applied in a tactical field care scenario or during interpretation.
man-carry stretcher evacuation. Even in the best-resourced All AAJT-S units used in the study were part of a large contin-
Western hospital, it takes 7–9 minutes to apply (even in the gent provided free of charge to Ukrainian Forces by Compres-
most experienced, well-lit, non-shaky hands). The placement sion Works, Inc., Birmingham, AL.
14
of a REBOA catheter requires skills in the use of ultrasound
and catheterization of central vessels; this is possible only at Author Contributions
the level of a medical specialist. AAJT-S is simpler and not in- DA conceived of the study and analyzed the data. AV assisted
vasive, so this skill can be taught during a short training for with the interpretation of data and writing.
combat medics, allowing for correct and quick application in
under one minute. 15 Disclosures
The authors have nothing to disclose.
Frequently, patients with severe abdominal injuries who did
not have an AAJT-S applied by combat medics on tactical Funding
evacuation care or by medics on Role 1 died on transport to No funding was provided for this work.
Role 2, even when blood was transfused (unpublished obser-
vations by our team). All bleeding must be stopped as early as References
possible; otherwise, no one will be alive to apply REBOA or 1. Lyon M, Shiver SA, Greenfield EM, et al. Use of a novel abdominal
perform DCS / damage control resuscitation. aortic tourniquet to reduce or eliminate flow in the common femo-
ral artery in human subjects. J Trauma Acute Care Surg. 2012;73(2
Suppl 1):S103–S105. doi:10.1097/TA.0b013e3182606219
Summary 2. Taylor D, Coleman M, Parker PJ. The evaluation of an abdom-
This study is the first wartime case series involving the use of inal aortic tourniquet for the control of pelvic and lower limb
the AAJT-S in the management of TCA. Other peer-reviewed, hemorrhage. Mil Med. 2013;178(11):1196–1201. doi:10.7205/
MILMED-D-13-00223
published data for TCA in a pre-hospital setting using the 3. Lyon M, Johnson D, Gordon R. Use of a novel abdominal aor-
AAJT-S have demonstrated ROSC in subjects with prolonged tic and junctional tourniquet to reduce or eliminate flow in the
asystolic times. We have seen that applying the AAJT-S at brachial and popliteal arteries in human subjects. Prehosp Emerg
5
the aortic bifurcation effectively and immediately stabilizes Care. 2015;19(3):405–408. doi:10.3109/10903127.2014.980479
the available circulatory volume and increases mean arterial 4. Rall J, Cox JM, Maddry J. The use of the abdominal aortic and
pressure. junctional tourniquet during cardiopulmonary resuscitation fol-
lowing traumatic cardiac arrest in swine. Mil Med. 2017;182(9):
e2001–e2005. doi:10.7205/MILMED-D-16-00409
Although the specific physiologic effects of the AAJT-S on 5. Balian F, Garner AA, Weatherall A, Lee A. First experience with the
CPR are not fully understood, researchers with the USAF abdominal aortic and junctional tourniquet in prehospital trau-
59th Medical Wing theorized “that AAJT application seques- matic cardiac arrest. Resuscitation. 2020;156:210–214. doi:10.
ters fluid resuscitation to the area above the tourniquet. This 1016/j.resuscitation.2020.09.018
would allow an overall increase in vascular pressure, cardiac 6. Yang Z, Tang D, Wu X, et al. A tourniquet assisted cardiopulmo-
4
preload, and coronary artery pressure.” When blood is trans- nary resuscitation augments myocardial perfusion in a porcine
model of cardiac arrest. Resuscitation. 2015;86:49–53. doi:10.
fused and CPR performed, the oxygenated blood is directed to 1016/j.resuscitation.2014.10.009
the vital organs more efficiently without having to be circu- 7. Rall J, Ross JD, Clemens MS, Cox JM, Buckley TA, Morrison
lated first to the pelvis and lower extremities. Further studies JJ. Hemodynamic effects of the abdominal aortic and junctional
are needed to look at this potential change to the management tourniquet in a hemorrhagic swine model. J Surg Res. 2017;212:
of TCA, including the later use of REBOA and DCS at the next 159–166. doi:10.1016/j.jss.2017.01.020
stages of trauma care. 8. Vianen NJ, Van Lieshout EMM, Maissan IM, et al. Prehospital
traumatic cardiac arrest: a systematic review and meta-analysis.
Eur J Trauma Emerg Surg. 2022;48(4):3357–3372. doi:10.1007/
While considerable progress has been made in managing hem- s00068-022-01941-y
orrhagic shock patients, ongoing research and adaptation are 9. Schechtman D, Kauvar DS, De Guzman R, et al. Abdominal aortic
crucial. Also, the possibility of using a sequential combination and junctional tourniquet versus zone III resuscitative endovascu-
of AAJT-S and REBOA at the pre-hospital stage in conditions lar balloon occlusion of the aorta in a swine junctional hemor-
of prolonged evacuation remains interesting for research. If rhage model. J Trauma Acute Care Surg. 2020;88(2):292–297.
doi:10.1097/TA.0000000000002553
anything good can come from this war for Ukraine’s survival, 10. Rall JM, Redman TT, Ross EM, Morrison JJ, Maddry JK.
it can at least be an invaluable platform for the advancement Comparison of zone 3 resuscitative endovascular balloon oc-
of our trauma care knowledge. clusion of the aorta and the abdominal aortic and junctional

68 | JSOM Volume 25, Edition 1 / Spring 2025