Page 126 - JSOM Fall 2025

FIGURE 4 Success rate of abdominal aortic and junctional tourniquet application after one hour of training
(median time for application).

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surveys after using the device and universally praised its battle- Notably, studies by Schechtman et al., Do et al., and
field applicability, ease of use, and potential to save lives. The Brännström et al. were designed to simulate TCCC scenarios
high usability ratings highlight its intuitive design and practi- or prolonged evacuation situations where access to defini-
cality in austere environments. Some criticism was directed at tive care is significantly delayed. While these studies provide
10
concerns over material durability, with some users concerned critical information on the use of the device in austere envi-
that the device might fail under stress. Notably, as a single-use ronments, their findings may not be directly generalizable to
device, the current AAJT model has since been improved with civilian trauma care. Nonetheless, they have highlighted the
enhanced materials based on user feedback. 10 potential utility of the AAJT in extreme conditions, an area
that requires further exploration.
Based on seven animal studies, it can be generalized that the
AAJT can prolong survival until the end of each observation Despite these challenges, the diversity of available literature is
period, even when different resuscitation strategies were em- also a strength. While the heterogeneity of studies precludes
ployed in swine models. Despite its limitations, the AAJT of- meta-analysis, it draws attention to key areas that require
fers clear advantages: it is cost-effective, practical, and quick standardized methodologies. The lack of consistency in study
to implement. 10,20 Compared to alternative interventions, its protocols complicates direct comparisons and emphasizes the
financial and logistical demands are minimal, making it a po- urgent need for consensus in research design to advance the
tentially valuable tool in prehospital trauma care. 20 field beyond its current fragmented state.

The AAJT is considered to be a device with low training re- Future Directions
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quirements, and Smith’s findings reinforce this assertion. The In the future, documented case series and reports will be essen-
indication of a possible elevation in the rate of ROSC could tial to expand the clinical knowledge base on the real-world ef-
be attributed to the positive resuscitative effects of AAJT, as fectiveness of the AAJT. Future clinical trials should investigate
observed in previous animal studies. 11–13 its impact on survival and neurological outcomes. Studies on
intermittent hemostasis, partial bladder inflation, and more pre-
Strengths and Limitations cise pressure areas in future EHCD designs may provide novel
Although this review has certain limitations, it also highlights strategies to mitigate ischemic complications. Studies regarding
critical gaps in the literature and provides a basis for future the AAJT in human patients provide the higher-level evidence
research. The main challenge was the limited availability of required to advance the field, regardless of the difficulties of
data on human patients, particularly in emergency services. producing randomized controlled trials with new emergency
This population would have been the ideal focus, firstly, given medicine interventions. Addressing these gaps is essential for
our research question, and secondly, because human data have evaluating the clinical value of abdominal aorta compression
fundamentally greater levels of evidence. Further, the risk of in both prehospital and hospital trauma care and ensuring its
bias in the AAJT animal studies is unclear on average. Never- optimal integration into EMS and military trauma protocols.
theless, the inclusion of animal studies provides valuable phys-
iological insights, even if variations in resuscitative strategies Despite significant advances in trauma care, hemorrhagic
obscure precise conclusions about the role of the AAJT in pro- shock remains associated with high mortality rates, highlight-
longing survival time. ing the urgent need for innovative interventions. The interplay

124 | JSOM Volume 25, Edition 3 / Fall 2025