P032: Twelve angry medics: a study of bimanual external aortic compression in healthy adult men

Abstract

Introduction: Following life-threatening hemorrhage the goal is to temporize blood-loss and expedite definitive-rescue. Junctional (abdominal-pelvic) trauma, between the inguinal ligament and umbilicus; is a leading cause of potentially survivable mortality. Numerous devices such as junctional tourniquets and resuscitative endovascular balloon occlusion of the aorta have been suggested for this injury pattern, but we propose an immediately available and expedient bimanual maneuver that may act as a bridge to device application, proximal external aortic compression (PEAC). Of note, external aortic compression has been used for centuries in life-threatening postpartum hemorrhage. Methods: Twelve paramedic volunteers were recruited from a continuing education event. Participant demographics, blood pressure, abdominal circumference, body mass index and procedural discomfort were recorded. In pairs, six participants were taught PEAC and performed the maneuver, then exchanged roles. Training consisted of researcher led demonstration and participant return demonstration with feedback. The duration of training was less than five minutes for all participants. Femoral artery hemostasis was measured by doppler ultrasound. Results: Participant mean age was 28.6 (range 22 to 46) and their mean systolic blood pressure was 128.25 mmHg (range 102 to 145). Mean body mass index was 24 (range 22 to 28) and abdominal girth was 80 cm (range 70 to 110). Bilateral common femoral artery blood flow became undetectable in all participants, by doppler ultrasound. Participant discomfort was reported as a mean of 4.4 (range 3 to 6) on a zero to ten scale. No complications were reported with seven and 30 days follow-up. Conclusion: This study demonstrates successful PEAC in twelve healthy participants. However, our limitations include a small sample and the relatively modest abdominal circumferences of our participants. If light of these limitations, PEAC may be a potentially life-saving maneuver which is immediately deployable and easy to learn, for patient temporization until device application and/or operative rescue.