Revue des moyens d'hémostase des hémorragies non compressibles

Perspectives on the management of non-compressible torso hemorrhage: A narrative review

Leclerc S et Al. Journal of Military, Veteran and Family Health 8(s2) 2022: 73-36

Hemorrhage is one of the leading causes of death after trauma. A significant proportion of these fatalities could be prevented with appropriate bleeding control. This is more easily achieved with direct pressure in compressible areas such as the extremities or major joints. However, bleeding in the chest, abdomen, or pelvis cannot be as easily controlled without advanced procedures that are only available in hospitals. This article describes several technologies to control bleeding in the chest, abdomen, and pelvis that are potentially applicable in combat and pre-hospital settings. However, a review of existing studies quickly shows that convincing clinical evidence is lacking to support most pre-existing technologies, and the majority of studies are in the investigational stage. A universal, effective, and life-saving solution has not yet been identified. Accordingly, research in this area should continue to focus on both refining existing technologies and developing new approaches.

More than 50% of combat casualty deaths on the battlefield occur minutes to hours after a person has been wounded. Approximately 25% of those fatalities could potentially be prevented if rapid hemorrhage control or temporization were feasible. Despite several technologies to temporize non-compressible torso hemorrhage (NCTH), an ideal device and method have not yet been developed, particularly for Role 1 military medical treatment facilities and civilian pre-hospital settings. This article summarizes the devices and adjunct methods currently available to temporize NCTH when surgical and interventional radiology control are not readily accessible. New technologies under investigation are also discussed.