LAUSR

Management of both battlefield and civilian trauma victims suffering from non-compressible torso hemorrhage (NCTH) remains a significant challenge with exsanguination continuing to be the leading cause of mortality from potentially survivable injuries.1–4 Death from hemorrhage may occur rapidly and often before arrival at a medical facility capable of providing definitive surgical hemostasis. Such challenges present a critical need for new technologies in the realm of pre-hospital and even early in-hospital hemostasis. Whether in the austere (battlefield) or the civilian prehospital emergency medical services environment, the ability to treat NCTH is very limited. Furthermore, logistical challenges such as transportation delays and mass casualty incidents highlight the need for providing temporary hemostasis before the arrival at a high-level care facility. In summary, most patients who succumb to NCTH do so in the pre-hospital or austere environment before surgical care because of limited resources. Even the ability to provide rapid temporary hemostasis in the emergency department or trauma center environment can present significant challenges. Surgical management remains the pinnacle treatment for NCTH, however, for the reasons mentioned above, is not viable as an early intervention near the point of injury. Coupled with the lack of resources for early resuscitation, mechanical hemorrhage control continues to be of interest to employ following the determination of severe hemorrhage in a forward setting. Current approved technologies for mechanical hemostasis include extremity and junctional tourniquets, pelvic binders, and endovascular balloon occlusion of the aorta. Additional investigational techniques such as abdominal insufflation and intra-abdominal foams are at various stages of development but are not currently cleared for clinical use.8–10