Stop Blood Flow, Save a Life


 
John Croushorn, MD uses the AAJT™ to save a life on the battlefield.
The Department of Defense has identified pelvic junctional bleeding as the number one priority for battlefield medicine, and the same problem also affects civilian populations. A new tourniquet device – the Abdominal Aortic and Junctional Tourniquet™ (AAJT) – treats both pelvic hemorrhage and severe bilateral lower junctional hemorrhage and is saving lives all over the world.

Developed with the cooperation of U.S. Army Special Operations, the AAJT™ addresses uncompressible hemorrhage that is not treatable by a tourniquet in the leg, groin and pelvis as well as the axilla and upper extremities. “In the military, research and development is requirements-driven, and one of the most critical needs we identified was stopping bleeding in the pelvis and areas where tourniquets cannot work,” says John Croushorn, MD, emergency medical physician and one of the inventors of the tourniquet.

After serving as a flight surgeon in Iraq, Croushorn worked with U.S. Army physician Richard Schwartz, MD, head of emergency medicine at Medical College of Georgia, to devise the inflatable tourniquet that buckles around a patient’s abdomen. Ted Westmoreland, a former combat medic with U.S. Army Special Operations, then helped refine the design further.

This tourniquet stops severe bleeding with its simple, mechanical design. “For pelvic bleeding, the medic buckles the device around a patient's abdomen, over the belly button, and then tightens it by twisting the windlass,” Croushorn says. “A hand pump inflates the wedge-shaped bladder, which compresses the patient's aorta, halting all blood flow to the pelvis and lower extremities.”

The AAJT™ has replaced a combat medicine technique of using the wounded soldier’s knee to apply pressure to his abdomen. While effective, it was not practical during transport of the victim.  According to Army reports, a device like this tourniquet could have prevented an average of three military deaths every month between October 2001 and April 2010.

Following animal trials, the device was approved for use by the FDA in 2011, and Croushorn’s company, Compression Works LLC, was born. “The military had asked for an expedited review, because our research was promising and had a life-saving capability that currently didn’t exist,” Croushorn says. “We found a manufacturer and completed the first run of devices in April of 2012.”

Devices were delivered to the Army in May 2012, and later that same year, the AAJT™ was named the Invention of the Year by Popular Science. Croushorn says that every component of the device is made in the United States. It is now available for EMS and hospital. Today, Compression Works has 15 global distributors in Europe, Canada, Latin and South Americas, and Australia.

The British were the first to save a life on the battlefield with the device in 2013, and Croushorn used it on two civilians at Baptist Princeton in Birmingham the same year. One had been shot in the armpit and another in the upper leg, and it saved both lives. “The military is focused on penetrating trauma from gunshots and explosions, but the device can save lives in the civilian world, too, like those at Princeton,” he says. “There is growing interest in the civilian population in areas that are not related to penetrating trauma.”

A foremost area of interest is the use of the AAJT™ in pelvic fracture bleeding, which affects around 115,000 people a year. Alabama’s state EMS directors, Sarah Nafziger and Elwin Crawford, are evaluating the use of the device in the EMS community.

“It is a serious problem, because medics who arrive at the scene of a car accident, for example, have no way to determine if the patient is bleeding from a pelvic fracture nor do they have a way to treat that type of bleeding,” Croushorn says. “If we can stop the bleeding and prevent shock until they arrive at the hospital, we can save a life. With the AAJT™, no one should die from pelvic fracture bleeding ever again.”

A second use for civilians has garnered interest in the world of cardiopulmonary resuscitation (CPR). During CPR, the abdominal tourniquet can be applied to shunt blood flow selectively to the heart, kidney, lung and brain, meeting CPR’s goal of maintaining blood flow to the vital organs until the heart can once again function independently.

“Aortic occlusion augments cardiopulmonary resuscitation by increasing coronary perfusion pressures during CPR,” Croushorn says. “It also provides for higher concentrations of cardio-effective medications like epinephrine or atropine into the heart quicker, because the device reduces distances these medications circulate through the body before reaching the heart. Similar findings are being reported with Retrograde Endothelial Balloon Occlusion of the Aorta (REBOA). The AAJY™ is equivalent to external REBOA, but faster and safer.”

Lastly, Croushorn says his product may provide a solution for the problem of post-partum hemorrhage in third-world countries. Currently, providers use intrauterine balloons to stop the bleeding. “It’s basically like a Foley catheter that is put into the uterus and inflated to stop the bleeding while the woman is transported to a doctor,” he says. “The problem is it doesn’t allow the uterus to contract down in size and it has to be put in by a provider. We believe the AAJT™ device can stop post-partum hemorrhage in these cases, and it can be applied by a non-physician.”

Compression Works is currently working on a second device that changes the pressure profile for use in intra-abdominal hemorrhage. “The research has found that this device stops bleeding from injuries to the liver, spleen, kidneys and bowels,” Croushorn says. “It works by increasing intra-abdominal compartment pressures through external pressure.”

Croushorn looks forward to the expanding use of the AAJT™ in pre-hospital providers in the U.S. and elsewhere. “Right now, SWAT teams, several large trauma centers and EMS agencies in the U.S. are the early adapters of the technology,” he says. “It’s great to see this technology make it to the civilian arena, providing a lifesaving piece of equipment that’s easy to use.”

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Tags:
abdominal aortic and junctional tourniquet; pelvic bleeding; uncompressible hemo

 

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