Page 121 - JSOM Fall 2025

An Ongoing Series

Effectiveness of External Hemorrhage Compression Device
of the Abdominal Aorta in Hemorrhagic Shock

A Systematic Review of the Literature

Jaakko Kuusisto, BM ; Kalle Mattila, MD, PhD ; Timo Iirola, MD, PhD ;
1
3
2
Anssi Heino, MD, PhD *
4

ABSTRACT
Introduction: Severe hemorrhage, notably non-compressible disability, and economic burden. They account for approxi-
torso hemorrhage (NCTH) leading to hemorrhagic shock and mately 10% of all years lived with disabilities and nearly 8%
traumatic cardiac arrest (TCA), represents a critical and chal- of global mortality, with 4.4 million lives lost annually. Among
lenging condition in trauma resuscitation. Despite advance- people aged 5–29 years, three of the five leading causes of
ments in hemorrhage control for extremities, NCTH continues death are injury-related, with traumatic cardiac arrest (TCA),
1
to present a significant barrier to survival, particularly in the a severe endpoint of hemorrhagic shock, being the leading
prehospital setting. The abdominal aortic and junctional tour- cause of death among young adults. Due to the severe fi-
2,3
niquet (AAJT), an external hemorrhage control device, has nancial and societal impact of trauma-related disabilities in
emerged as a promising tool for addressing junctional and ab- working-age adults (29–65 years), the World Health Orga-
dominal hemorrhages, yet its clinical effectiveness remains inad- nization has identified injury prevention as a key sustainable
equately explored. This review assesses the efficacy of the AAJT development goal. Despite this recognition, physical trauma
1,4
in improving survival rates in patients with hemorrhagic shock. continues to have devastating consequences worldwide, per-
Methods: A systematic literature search was conducted per petuating a cycle in which medical advances in some areas fail
PRISMA guidelines. Only English-language publications pub- to translate into broader survival benefits.
lished between 2019 and 2024 were included. Results: Of the
nine relevant publications identified, one was a descriptive case One notable success in trauma care has been hemorrhage con-
series, seven were animal model studies, and one examined the trol in extremity injuries, where the use of hemostatic gauze
practicality of the AAJT when tested by combat medic techni- and tourniquets has significantly reduced mortality. How-
5,6
cians. Conclusions: The sparse literature did not permit a proper ever, these innovations do not address one of the most lethal
systematic analysis or conclusions on the clinical effectiveness of and difficult-to-manage aspects of trauma—non- compressible
AAJT in human patients. The AAJT remains a forward-thinking torso hemorrhage (NCTH). Unlike limb injuries, NCTH re-
and viable option for improving trauma resuscitation protocols. mains largely untreatable in the prehospital setting due to
Further studies, particularly randomized and controlled clinical bleeding from major torso vessels, high-grade solid organ in-
trials, are required to advance this research. juries (liver, spleen, kidney), or complex pelvic fractures. The
inability to control this bleeding often results in rapid exsan-
Keywords: aorta, abdominal; tourniquets; heart arrest; guination, hemorrhagic shock, and TCA, contributing to the
hemorrhage; abdominal aortic and junctional tourniquet; relentless cycle of trauma-related mortality. 7
traumatic cardiac arrest; non-compressible torso hemorrhage;
external aortic compression; prehospital care The direct relationship between NCTH, hemorrhagic shock,
and TCA makes this a particularly urgent area of focus. Once
a patient progresses to TCA, survival rates drop below 10%,
with outcomes strongly linked to early intervention; shorter
Introduction
delays in initiating cardiopulmonary resuscitation, faster emer-
Physical injuries remain one of the most pressing global health gency medical services (EMS) arrival, and reduced reliance on
challenges, driving a cycle of preventable death, long-term epinephrine have all been associated with improved survival.
8
*Correspondence to Kerosiinitie 61, 20360 Turku, Finland or anssi.heino@tyks.fi
1 Jaakko Kuusisto is affiliated with the University of Turku, Turku, Finland. Dr. Kalle Mattila is affiliated with the Emergency Department at
2
Turku University Hospital and the University of Turku, Turku, Finland. Dr. Timo Iirola and Dr. Anssi Heino are affiliated with Emergency Medi-
3
4
4
cal Services at the Wellbeing Services County of Southwest Finland and the University of Turku, Turku, Finland. Dr. Anssi Heino is affiliated with
the Department of Perioperative Services, Intensive Care Medicine and Pain Management and the Department of Anaesthesiology and Intensive
Care, Turku University Hospital, Turku, Finland.
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