Table 2 List of identified prehospital treatment options
Class | Adjunct | Name | Manufacturier | Pro’s | Con’s |
|---|---|---|---|---|---|
Junctional tourniquets | CRoC™ | Combat Ready Clamp™ | Combat medical systems. Fayetteville, NC | Easy. 4 h max | Dislodgement, heavy, limb ischemia, longer application time than other JT’s |
JETT™ | Juntional Emergency Tourniquet Tool™ | North American Rescue Products. Greer, SC | Easy. 4 h max. Stabilizes pelvis | No reports of clinical use | |
SAM-JT™ | SAM Junctional Tourniquet™ | SAM Medical Products. Wilsonville, OR | Easy. 4 h max. Stabilizes pelvis | Little experience | |
AAJT™ | Abdominal Aortic and Junctional Tourniqet™ | Compression Works. Hoover, AL | Axillary, inguinal and truncal application. External compression of the abdominal aorta | Easily broken. Uncomfortable in truncal application. Truncal max 1 h. In penetrating trauma CI for truncal placement | |
Wound clamp | iTC™ | iTClamp™ | Innovative Trauma Care. San Antonio, TX | Very easy, any location | Only superficial seal, hematoma |
Haemostatic agent | XStat-30™ | XStat-30™ | RevMedx. Wilsonville, OR | Easy, tailored for deep penetrating wounds | Only junctional, removal of sponges |
REBOA | 9-14 Fr | Coda™ Balloon Catheter | Cook Medical, Indianapolis, IN | Proximal control, raises central aortic pressure | Invasive, requires physician, risk at (spinal) ischemia, challenging, time consuming |
7 Fr | ER-REBOA™ | Pryor Medical. Arvada, CO | |||
Intra-abdominal gas insufflation | - | - | - | Minor invasive. Less risk at pressure necrosis than foam. | Abdominal compartment syndrome, risk of air embolisms, experimental |
Intra-abdominal self-expanding foam | ResQFoam™ | ResQFoam™ | Arsenal Medical. Waterland, MA | Tamponade of abdominal compartment, less invasive then RT/REBOA, no physician required | Pressure necrosis, abdominal compartment syndrome, needs surgical removal, experimental |
Pelvic stabilizer | T-POD™ | Trauma Pelvic Orthotic Device™ | Pyng Medical. Richmond, Canada | Easy applicable, wide experience, enables REBOA/AAJT | Insufficient if origin of haemorrhage is arterial |
SAM-sling™ | SAM-sling™ | SAM Medical Products. Wilsonville, OR | |||
PelvicBinder™ | PelvicBinder™ | PelvicBinder Inc. Dallas, TX | |||
Pelvic Sheet | - | - | - | Low cost, widely available | Inadequate application, dislodgement |
Resuscitative Thoracotomy | - | - | - | Very proximal control, raises central aortic pressure. | Invasive, risk at infection, requires physician |