Laboratory Assessment of Out-of-hospital Interventions to Control Junctional Bleeding from the Groin in a Manikin Model.

摘要

Junctional body regions between the trunk and its appendages, such as the groin, are too proximal for a regular limb tourniquet to fit [1,2]. Not since 1993 s Black Hawk Down has junctional hemorrhage control become such a hot topic in military casualty care [1 7]. In February 2013, the US military s Task Force Medical Afghanistan requested a fill of a gap in junctional hemorrhage control as an urgent operational need, meaning that junctional hemorrhage control devices should be considered urgently to fill a gap in medical care in war. A small but growing body of evidence indicates that hemorrhage control can be attained out-of-hospital with mechanical compression, using such interventions as medical devices, on a pressure point proximal to a bleeding wound [3 9]. To evaluate laboratory use of junctional hemorrhage control interventions, wegathered data on stopping groin bleeding in a manikin model to understand the plausibility of such interventions for future human subject research. Under an approved protocol, we tested efficacy of interventions in a manikin designed to trainmedics in out-of-hospital hemorrhage control (Combat Ready Clamp [CRoC] Trainer Manikin, Operative Experience, Inc, North East,MD).We filled the blood reservoirwith 4 liters ofwater; we refilled the reservoir after 5 iterations or 1.5 liters of lost fluid, whichever came first. The manikin had a right-groin gunshot wound through the proximal thighwhere the common femoral artery flow was controllable by skin compression over it at the level of the inguinal fold. There was 3 cm between the pressure point where compression was applied and the proximal extent of the wound. Interventions were timed, blood loss was measured, and efficacy was noted. Efficacy was operationally defined as visually stopped flow into the wound fromthe vessel lumen.