Use of a Novel Abdominal Aortic and Junctional Tourniquet to Reduce or Eliminate Flow in the Brachial and Popliteal Arteries in Human Subjects

Background. Penetrating injuries of the proximal large arteries are a common cause of death on the battlefield due to rapid exsanguination. Applying an effective tourniquet to stop bleeding at the axillary and proximal femoral arteries (junctional sites) is difficult. Prior studies have shown that the Abdominal Aortic and Junctional Tourniquet (AAJT) effectively reduced blood flow in the common femoral artery with application of the device around the lower abdomen. Our objective was to determine the effectiveness of the AAJT to stop blood flow in the proximal femoral artery (PFA), and the axillary artery (AA). Method. This was a prospective observational trial using human volunteers. The AAJT consists of a wedge-shaped bladder and integrated strap. The bladder has an integrated manometer, which is used to measure the pressure in the bladder. For the AA, the AAJT was placed over the axillary junction at the anterior axillary line with the strap placed across the contralateral shoulder. For the PFA, the AAJT bladder was placed over the right groin with the strap positioned across both femoral trochanters. Spectral Doppler measurements were taken of the PFA and AA at baseline and as the bladder was inflated. Collected data included pressure of the AAJT bladder at baseline, when the arterial tracing showed change in flow and cessation of flow. A 10-point verbal pain scale (Rate your pain, with 0 = no pain, 10 = severe pain) also was used at each of these points. Results. A total of 13 male participants were enrolled and completed the project. In all participants (13/13), blood flow in both the PFA and the AA was stopped, as measured by no spectral Doppler flow in the distal artery. For the PFA and AA, mean bladder pressure at zero Doppler flow was 148.5 and 168 mmHg, respectively. Pain atmaximum bladder pressure averaged 3.6 and 4.1 and returned to 0 after AAT removal. Conclusion. The AAT was uniformly effective in stopping flow in the proximal femoral artery and the axillary artery after application of the AAT across the proximal chest and lower pelvis.