Page 123 - JSOM Fall 2025

FIGURE 1 Flowchart for study search, selection, and screening for the review.

Records identified
through database search
n=21

Duplicates removed Titles screened
n=1 n=20

Records excluded Article abstracts
based on title assessed for eligibility
n=6 n=14

Articles excluded Articles eligible for
based on abstract full-text screening
n=5 n=9

Records excluded
based on full-text
n=0

Studies included
n=9

The Australian descriptive case series on AAJT usage in TCA euthanized at the end of the observation period, which was set
patients consisted of 18 applications of the AAJT, from which after the device had been removed. The deceased subjects in
data were collected and analyzed. the animal studies (Figure 2) refer specifically to subjects who
died before the end of the observation period. The individual
A study on the utility of the AAJT was conducted on British application and observation periods for each study are listed
CMT volunteers. In this study, the CMTs were first trained in Table 2. However, a direct comparison of these time periods
in the use of the AAJT, after which the rate of successful ap- with the case series of Balian et al. is not possible due to fun-
plications was studied both in daylight and low-light condi- damental differences in study design and patient management.
tions. The CMTs also provided open feedback on the use of
the AAJT. The Rate of ROSC achieved with the AAJT
Data on ROSC achieved were collected from two studies: the
The Clinical Effectiveness of the AAJT case series by Balian et al. and a randomized animal study by
in the Survival of TCA Patients Brännström et al. Despite involving only deceased patients,
Data on the primary parameter—human patient survival— Balian et al. noted a return of ROSC in two patients, one of
were obtained from a case series by Balian et al., which ex- whom proceeded to organ donation. Because their findings
20
amined AAJT application in TCA patients within an HEMS were consistent with those of previous animal model studies,
setting in Sydney, Australia. The study included 18 prehospital it was theorized that earlier application might increase the rate
TCA patients treated with AAJT applications. However, the of ROSC and survival. 20
intervention did not improve survival, as all patients eventu-
ally succumbed to their injuries, resulting in a 100% mortality In Brännström’s study, where the transition from AAJT to
rate (see the last columns in Figure 2). REBOA was studied, one case of ventricular fibrillation was
observed as an unplanned hazard not included in the study’s
In contrast, all of the animal studies included in this review initial design. ROSC was achieved in under 30 seconds of re-
followed a standardized protocol in which the subjects were suscitation after the AAJT was applied (Figure 3). With no

Compression of Abdominal Aorta in Hemorrhagic Shock: Systematic Review | 121