title: Traumatic intra-abdominal hemorrhage control: has current technology tipped the balance toward a role for prehospital intervention?
abstract: BACKGROUND
  The identification and control of traumatic hemorrhage from the torso remains a major challenge and carries a significant mortality despite the reduction of transfer times. This review examines the current technologies that are available for abdominal hemorrhage control within the prehospital setting and evaluates their effectiveness.
  
  
  METHODS
  A systematic search of online databases was undertaken. Where appropriate, evidence was highlighted using the Oxford levels of clinical evidence. The primary outcome assessed was mortality, and secondary outcomes included blood loss and complications associated with each technique.
  
  
  RESULTS
  Of 89 studies, 34 met the inclusion criteria, of which 29 were preclinical in vivo trials and 5 were clinical. Techniques were subdivided into mechanical compression, endovascular control, and energy-based hemostatic devices. Gas insufflation and manual pressure techniques had no associated mortalities. There was one mortality with high intensity focused ultrasound. The intra-abdominal infiltration of foam treatment had 64% and the resuscitative endovascular balloon occlusion of the aorta had 74% mortality risk reduction. In the majority of cases, morbidity and blood loss associated with each interventional procedure were less than their respective controls.
  
  
  CONCLUSIONS
  Mortality from traumatic intra-abdominal hemorrhage could be reduced through early intervention at the scene by emerging technology. Manual pressure or the resuscitative endovascular balloon occlusion of the aorta techniques have demonstrated clinical effectiveness for the control of major vessel bleeding, although complications need to be carefully considered before advocating clinical use. At present, fast transfer to the trauma center remains paramount.
  
  
  METHODS
  Systematic review, level IV.
authors.affiliation: From The Hamlyn Centre for Robotic Surgery (M.C., J.C., G.-Z.Y., A.D.), and Department of Surgery and Cancer (M.H.W., D.B.), Imperial College London; and Department of Trauma Surgery (D.B.), Kings College Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: Muzzafer
authors.initials: M
authors.lastname: Chaudery
authors.forename: James
authors.initials: J
authors.lastname: Clark
authors.forename: Mark H
authors.initials: MH
authors.lastname: Wilson
authors.forename: Duncan
authors.initials: D
authors.lastname: Bew
authors.forename: Guang-Zhong
authors.initials: GZ
authors.lastname: Yang
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
mesh_terms: D000007:Abdominal Injuries / Q000401:mortality / Q000628:therapy*; D004638:Emergency Treatment; D006470:Hemorrhage / Q000401:mortality / Q000628:therapy*; D006801:Humans