Use of a novel abdominal aortic tourniquet to reduce or eliminate flow in the common femoral artery in human subjects

Background: Penetrating injuries of proximal femoral and iliac vessels are a common cause of death on the battlefield. Previous studies have shown that by applying 80 lb to 140 lb of pressure externally over the distal abdominal aorta, flow can be ceased in the common femoral artery (CFA). It has also been demonstrated that in a porcine model, an externally applied pneumatic abdominal aortic tourniquet (AAT) can occlude the aorta and inferior vena cava for 60 minutes without bowel injury or significant potassium elevations.The objectives of this study were (1) determine if AAT use in humans results in flow cessation in the CFA, (2) measure the pressure required to cease flow in the CFA, and (3) measure discomfort associated with application of the AAT. Methods: Pulse wave Doppler measurements were taken in supine volunteers at the right CFA. The AAT was placed just above the iliac crests over the anterior abdomen. The AAT was inflated using a hand pump with an integrated manometer. Measurements were taken every 30 mm Hg. Discomfort was measured using a 10-point pain scale. Results: In all subjects, flow was reduced in the CFA. Flow ceased in seven of nine subjects at a median pressure of 180 mm Hg (150-230 mm Hg). Median discomfort at ceasing of flow was 7 (3-10), returning to 0 after device removal. Conclusion: The AAT device was effective at reducing flow in the CFA and ceased flow in most of the subjects. Application of the device was associated with discomfort varying from moderate to severe and resolving with device removal.