title: Abdominal aortic and iliac artery compression following penetrating trauma: a study of feasibility.
abstract: BACKGROUND
  Penetrating junctional trauma is a leading cause of preventable death on the battlefield. Similarly challenging in civilian settings, exsanguination from the vessels of the abdomen, pelvis, and groin can occur in moments. Therefore, iliac artery or abdominal aortic compression has been recommended. Based on prior research, 120 lbs (54 kg) or 140 lbs (63 kg) of compression may be required to occlude these vessels, respectively. Whether most rescuers can generate this amount of compression is unknown.
  
  
  OBJECTIVE
  To determine how many people in a convenience sample of 44 health care professionals can compress 120 lbs and 140 lbs.
  
  
  METHODS
  This study simulated aortic and iliac artery compression. Consent was obtained from 44 clinicians (27 female; 17 male) from two large urban hospitals in Edmonton, Alberta, Canada. Participants compressed the abdominal model, which consisted of a medical scale and a 250 ml bag of saline, covered by a folded hospital blanket and placed on the ground. In random order, participants compressed a force they believed maintainable for 20 minutes ("maintainable effort") and then a maximum force they could maintain for two minutes ("maximum effort"). Compression was also performed with a knee. Descriptive statistics were used to evaluate the data.
  
  
  RESULTS
  Compression was directly proportional to the clinician's body weight. Participants compressed a mean of 55% of their body weight with two hands at a maintainable effort, and 69% at a maximum effort. At maintainable manual effort, participants compressed a mean of 86 lbs (39 kg). Sixteen percent could compress over 120 lbs, but none over 140 lbs. At maximum effort, participants compressed a mean of 108 lbs (48 kg). Thirty-four percent could compress greater than 120 lbs and 11% could compress greater than 140 lbs. Using a single knee, participants compressed a mean weight of 80% of their body weight with no difference between maintainable and maximum effort.
  
  
  CONCLUSIONS
  This work suggests that bimanual compression following penetrating junctional trauma is feasible. However, it is difficult, and is not likely achievable or sustainable by a majority of rescuers. Manual compression (used to temporize until device application and operative rescue) requires a large body mass. To maintain 140 lbs of compression (for example during a lengthy transport), participants needed to weigh 255 lbs (115 kg). Alternatively, they needed to weigh 203 lbs (92 kg) to be successful during brief periods. Knee compression may be preferable, especially for lower-weight rescuers.
authors.affiliation: 1Collaborative Program in Resuscitation Science, Faculty of Medicine,University of Toronto,Toronto,Ontario,Canada.
authors.forename: Matthew
authors.initials: M
authors.lastname: Douma
authors.affiliation: 2Division of Critical Care Medicine,University of Alberta,Edmonton,Alberta,Canada.
authors.forename: Peter George
authors.initials: PG
authors.lastname: Brindley
mesh_terms: D000007:Abdominal Injuries / Q000209:etiology / Q000628:therapy*; D000416:Alberta; D001012:Aorta, Abdominal / Q000293:injuries*; D001835:Body Weight; D002983:Clinical Competence; D004638:Emergency Treatment / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006470:Hemorrhage / Q000209:etiology* / Q000517:prevention & control*; D006489:Hemostatic Techniques; D006801:Humans; D007083:Iliac Artery / Q000293:injuries*; D008297:Male; D011312:Pressure; D012965:Sodium Chloride; D013997:Time Factors; D014950:Wounds, Penetrating / Q000150:complications*
chemical_list: D012965:Sodium Chloride