title: Conceptualized Use of Self-Expanding Foam to Rescue Special Operators From Abdominal Exsanguination: Percutaneous Damage Control for the Forward Deployed.
abstract: BACKGROUND
  Noncompressible hemorrhage is the leading cause of potentially survivable death on the battlefield. In Special Operations Forces (SOF), 50% of potentially survivable deaths have been related to noncompressible hemorrhage. Currently, there are no widely available presurgical interventions that can slow abdominal bleeding. Consequently, many of the preventable deaths occur en route to definitive care as a failure to rescue from exsanguination. A self-expanding polyurethane foam has been developed as a percutaneous damage control intervention to rescue casualties who would otherwise die of noncompressible hemorrhage, and allow them to survive long enough to reach surgical intervention. The purpose of this paper is to summarize the existing preclinical data, describe the role of SOF personnel in foam delivery-system development, and to integrate these together to conceptualize how foam could be incorporated into SOF medical care.
  
  
  METHODS
  All existing publications on self-expanding foam are reviewed. Additionally, eight SOF medical providers with combat experience provided end-user input to delivery-device design through an interactive human-factors testing process.
  
  
  RESULTS
  Ten preclinical publications described efficacy, safety, dose translation, and risk-benefit analysis of exsanguination rescue with percutaneous-foam damage control. SOF medical providers guided weight, cubic, operational requirements, and limits for the foam delivery device.
  
  
  CONCLUSIONS
  Presurgical exsanguination rescue with percutaneous foam damage control is safe and effective with a favorable risk-benefit profile in preclinical studies. Battlefield, presurgical use by SOF medical providers is conceptually possible. Adoption of the technology on the battlefield should proceed with SOF medical provider input.
authors.forename: Adam P
authors.initials: AP
authors.lastname: Rago
authors.forename: Upma
authors.initials: U
authors.lastname: Sharma
authors.forename: Kyle
authors.initials: K
authors.lastname: Sims
authors.forename: David R
authors.initials: DR
authors.lastname: King
mesh_terms: D000007:Abdominal Injuries / Q000150:complications; D058450:Endotamponade / Q000295:instrumentation / Q000379:methods*; D058734:Exsanguination / Q000209:etiology / Q000628:therapy*; D005392:First Aid / Q000379:methods*; D006490:Hemostatics / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008889:Military Personnel; D011140:Polyurethanes / Q000627:therapeutic use*; D014481:United States
chemical_list: D006490:Hemostatics; D011140:Polyurethanes; C028279:polyurethane foam