Stabilisation pelvienne par garrot tourniquet: Parait OK

 

COMBAT-TIP: Combat-Optimized Method for Bone Alignment and Tourniquet Innovation in Pelvic Fractures, A Comparative Study on Pelvic Fracture Stabilization

Mathew Saab M et Al. Wilderness Environ Med. 2025 Dec 15:10806032251395945.

 

 

Introduction

 

Pelvic fractures pose a significant treatment challenge in the prehospital environment, often resulting from high-energy trauma and concurrently presenting with life-threatening hemorrhage necessitating immediate intervention. Commercial pelvic binders such as the Structural Aluminum Malleable (SAM) Pelvic Sling II have become commonplace in prehospital care, especially in military medicine. However, given limitations to carried equipment and the scarcity of pelvic fractures, medics in austere conditions may opt to carry just one or even no commercial pelvic binders.

 

Objective

 

This study explored an innovative approach using 2 Combat Application Tourniquet II (CAT II) devices tandemly connected to stabilize pelvic fractures. The primary aim was to assess whether this technique will generate comparable intrapelvic pressure to the SAM Pelvic Sling II.MethodsThis study employed a human cadaveric model for which pelvic fractures were surgically created to generate an open-book fracture. Intrapelvic pressure was measured via a Foley catheter. The SAM Pelvic Sling II was applied in standard fashion 3 times, each with intrapelvic pressure recorded. Similarly, 2 CAT IIs were applied in tandem to the pelvis 3 times to generate 3 pressure measurements.

 

Results

 

There was a small yet statistically significant increase in intrapelvic pressure generated by the CAT II method than by the traditional method.

 

Conclusion

 

The use of 2 CAT II devices connected in the fashion described in this study appears to offer a potentially feasible and effective alternative for stabilizing pelvic fractures. Yet, further investigation is required before this concept is ever applied to real patients.

Pst Hémostatique et temérpatures extrêmes: C'est OK

Impact of Extreme Temperatures on Hemostatic Gauze Using Thromboelastography

Ockenfels BA et Al. Wilderness Environ Med. 2026 Mar;37(1):32-37.

 

 

Introduction

 

Hemorrhage control in austere environments is challenging, particularly for wounds that are not amenable to tourniquets. Hemostatic gauzes are crucial in such settings, but their efficacy may be compromised by suboptimal storage conditions, including extreme temperatures, where discoloration has been observed. This study evaluated the impact of extreme temperature exposure on the efficacy of hemostatic gauze using thromboelastography.

 

Methods

 

Blood from 30 healthy adults was diluted by 30% with hetastarch to mimic trauma-induced coagulopathy. Kerlix and QuikClot Combat Gauze stored for 3 weeks in cold (-10°C), hot (70°C), and room-temperature (22°C) environments were compared in the thromboelastography parameters of R (time to initiation of clot formation), K (clot amplification), α angle (clot formation rate), and MA (maximum amplitude of clot).

 

Results

 

Compared with whole blood, diluted blood had weaker clots with slower clot-formation kinetics (MA=58 vs 43 mm, P<0.0001; K=2.6 vs 4.0 min, P<0.0001; α angle=55 vs 47 degrees, P<0.0003) but faster clot initiation times (R=8.7 vs 7.1 min, P<0.0001). Addition of either gauze shortened clot initiation times (Kerlix: 7.1 vs 5.0 min, P<0.0001; QuikClot Combat Gauze: 7.1 vs 2.7 min, P<0.0001), with QuikClot Combat Gauze significantly shortening R compared with Kerlix. Reductions in R values were consistent across temperature extremes (P<0.05). The other parameters were consistently unaffected (P>0.05).

 

Conclusions

 

This in vitro laboratory study demonstrated that hemostatic gauze retained its ability to initiate clotting in vitro even after prolonged exposure to temperature extremes.

Hémorragie des blessés de guerre: Quoi de disponible ?

Initial management of haemorrhagic war casualties: tactical priorities and innovative approaches in modern and future warfare

Jarrassier A et Al. Crit Care. 2025 Nov 28;29(1):509. 

 

--------------------------------

Une très bonne présentation des moyens de prise en charge des hémorragies des blessés de guerre
--------------------------------

 

Background: Haemorrhage remains the leading cause of preventable death in modern armed conflict, affecting both combatants and civilians. Recent conflicts-particularly the ongoing conflict in Ukraine- have highlighted the increasing complexity of battlefield injuries, characterised by hybrid warfare, disrupted evacuation chains, and delayed access to definitive surgical care. These realities challenge traditional trauma paradigms, such as the "Golden Hour" and demand adaptation of haemorrhage control and resuscitation strategies to austere environment.

 

Content: This narrative review synthesizes current practices and emerging innovations in the initial management of haemorrhagic shock in combat. Immediate haemorrhage control techniques-such as tourniquets, pelvic binders, direct vessel clamping, and external or endovascular aortic occlusion-are examined for their tactical relevance and impact on survival. The review underscores the role of haemostatic dressings and both topical and injectable haemostatic agents in controlling non-compressible bleeding. Damage control resuscitation centres on early administration of blood products in a 1:1:1 ratio or when available, low‑titer group O whole blood (LTOWB), combined with permissive hypotension and prevention of hypothermia. Whole blood and LTOWB are now routinely used by several armed forces, particularly the US and French armies, simplifying logistics and improving haemostatic efficacy during prehospital and tactical resuscitation. In cases of major haemorrhage, a transfusion protocol can be facilitated by novel products, such as leucocyte-depleted whole blood and freeze-dried blood products. Tranexamic acid, when administered within the first three hours after injury, halves mortality in massively transfused casualties, consistent with major international guidelines. Operational innovations address evacuation delays: forward damage-control surgery by lightweight Role 1/2 teams; drone delivery of blood components and medicines over distances from short range to>100 km, depending on platform capability and regulatory clearance; and prototype drone platforms for casualty evacuation (CASEVAC). Advanced technologies-such as closed-loop fluid systems, digital-twin physiology models, and AI-assisted triage-are poised to standardise care and reduce cognitive load for providers in austere settings.

 

Conclusion: The integration of haemorrhage control, targeted resuscitation, and logistical innovation defines the modern approach to managing war-related haemorrhagic shock. While challenges remain in evidence generation and field implementation, emerging practices-grounded in operational experience-are progressively improving survival. Ongoing investment in research, training, and technological adaptation will be essential to reducing preventable deaths on future battlefields.

Hydrogel hémostatique: Cela arrive

The next frontier in hemorrhagic management: A comprehensive review on development of natural polymer-based injectable hydrogels as promising hemostatic dressings

Sanya A et Al. Chemical Engineering Journal  10.1016/j.cej.2024.155033

-----------------------------

L'idée d'injecter un produit hémostatique (poudre, petites épnges, gel) au contact d'une lésion qui saigne n'est pas nouvelle et de nombreux travaux de recherche sont en train  de paraître dans la littérature (1, 2). Cet article fait une courte synthèse des enjeux de ce type de produit qui paraissent bien complémentaire des moyens mécanique d'arrêt des hémorragies.

-----------------------------

Unmet needs in controlling uncontrolled hemorrhage in emergency, surgical, and battlefield scenarios have sparked widespread interest in developing new hemostatic technologies. Despite the availability of a wide range of commercially available hemostats, sealants, and adhesives, the development of ideal hemostatic formulations with remarkable properties such as the ability to promptly staunch bleeding under wet and dynamic conditions remains a challenge. Injectable polymeric hydrogels with superior hemostatic qualities besides their irregular wound filling capability, and minimal invasiveness have received considerable interest in recent years because of their attractive properties particularly useful in bleeding management. In this article, the most recent advances in the fabrication of injectable hydrogel systems from natural polymers towards hemostatic applications are discussed based on an extensive review of the literature. Additionally, the inherent hemostatic attributes of each polymer have been highlighted alongwith a comprehensive overview of various mechanisms through which injectable hydrogels achieve hemostasis. Furthermore, the challenges that need to be tackled towards accelerating the translation of these novel hemostatic hydrogel systems to clinical practice are emphasized and future directions for research in the field are also presented.

 

Parmi ces produits: le TraumaGel

Garrot mieux que les autres moyens? Et bien pas si sûr

Is the Use of Tourniquets More Advantageous than Other Bleeding Control Techniques in Patients with Limb Hemorrhage? A Systematic Review and Meta-Analysis

Cirocchi R et Al. Medicina (Kaunas). 2025 Jan 9;61(1):93

--------------------------

Une méta analyse qui jette un peu d'ombre sur le sacro-saint tourniquet, surtout quand il n'est pas bien utilisé. Un retour vers les pansements compressifs ? Probablement pas? surtout surveiller ces garrots et savoir les convertir correctement.

--------------------------

 

Background and Objectives:

Trauma, particularly uncontrolled bleeding, is a major cause of death. Recent evidence-based guidelines recommend the use of a tourniquet when life-threating limb bleeding cannot be controlled with direct pressure. Prehospital hemorrhage management, according to the XABCDE protocol, emphasizes the critical role of tourniquets in controlling massive bleeding. The aim of this systematic review and meta-analysis was to summarize data from the available scientific literature on the effectiveness of prehospital tourniquet use for extremity bleeding.

Materials and Methods:

A systematic review and meta-analysis was performed between March 2022 and March 2024, adhering to PRISMA guidelines, to determine whether prehospital tourniquets are clinically effective. The protocol was published on PROSPERO (ID number: CRD42023450373).

Results:

A comprehensive literature search yielded 925 articles and 11 studies meeting the inclusion criteria. The analysis showed a non-statistically significant reduction in mortality risk with tourniquet application (4.02% vs. 6.43%, RR 0.70, 95% CI 0.46-1.07). Analysis of outcomes of amputation of the traumatized limb indicated a statistically higher incidence of initial amputation in the tourniquet group (19.32% vs. 6.4%, RR 2.07, 95% CI 1.21-3.52), while delayed amputation showed no difference (9.39% vs. 3.66%, RR 0.93, 95% CI 0.42-2.07). Tourniquet use demonstrated a non-significant reduction in the number of blood components transfused (MD = -0.65; 95% CI -5.23 to 3.93 for pRBC, MD = -0.55; 95% CI -4.06 to 2.97 for plasma).

Conclusions:

Despite increasing use in civilian settings, this systematic review and meta-analysis showed no significant reduction in mortality or blood product use associated with prehospital tourniquet use. Further research, including high-quality randomized controlled trials, is required, as well as awareness and education campaigns relating to proper tourniquet use in the prehospital setting.

Foley ou Seringue ?

The effectiveness of Foley catheter balloon tamponade versus expanding sponges and hemostatic granules for catastrophic penetrating groin hemorrhage with small skin defect: A comparative study in a live tissue porcine model with evaluation of a concise training program

 

Vrancken SM et Al. J Trauma Acute Care Surg. 2023 Apr 1;94(4):599-607

 

--------------------------------------

Il est proposé d'utilser l'administration locale d'hémostatiques pour arrêter les hémorragies notamment jonctionelles. Ceci est en théorie efficace. Néanmoins il s'agit de produits onéreux et des moyens simples comme l'emploi de sond à ballonet est également proposé. Ce travail confirme la pertinence d'une telle démarche, notamment le XStat. Mais il montre aussi qu'une sonde à ballonet est pratiquement aussi efficace. Alors, surtout ne pas se priver.

--------------------------------------

 

Background: Prompt bleeding control in the prehospital phase is essential to improve survival from catastrophic junctional hemorrhage. This study aimed to compare the effectiveness and practicality of Foley catheter balloon tamponade (FCBT), Celox-A, and XSTAT for the treatment of catastrophic hemorrhage from penetrating groin injuries with a small skin defect in a live-tissue porcine model. In addition, this study aimed to determine whether a training program could train military personnel in application of these advanced bleeding control adjuncts.

 

Methods: A standardized wound was created in 18 groins from 9 anesthetized swine. Eighteen military medics participated in the training program and performed a bleeding control procedure after randomization over the swine and test products and after transection of the femoral neurovascular bundle. Primary endpoints were bleeding control, time to bleeding control, rebleeding, blood loss, medic performance, and user product rating.

 

Results: No significant differences were found in vital signs and laboratory values between the groups. In the Celox-A group, 3/6 groins achieved hemorrhage control. This was 6/6 in the XSTAT and FCBT groups. XSTAT scored best on application time, time to obtain hemorrhage control, hemorrhage control score, and practicality. No significant differences were found between groups for rebleeding, amount of blood loss, and medic performance. Military medics had a significant higher preference for XSTAT over Celox-A. This was not significant for FCBT.

 

Conclusion: All tested products proved effective in obtaining hemorrhage control. XSTAT has the highest effectivity and shortest application time for the treatment of catastrophic bleeding from nonpackable, penetrating junctional groin injuries with a small skin defect, compared with Celox-A and FCBT. XSTAT scored best on practicality. This study shows that our training curriculum can be used to train military medics with limited prior experience in the use of advanced bleeding control techniques for penetrating junctional groin injuries with small skin defect.

Exsufflation: KT trop longs ? Attention à gauche

Meta-analysis of the optimal needle length and decompression site for tension pneumothorax and consensus recommendations on current ATLS and ETC guidelines

Ahmad SJS et Al. World J Emerg Surg. 2025 May 19;20(1):39

 

-------------------------

Un bémol sur l'emploi non discerné des cathéters actuellement proposés par l'industrie. Comme toujours primum non nocere

-------------------------

Background

Tension pneumothorax (TP) is a life-threatening condition. The immediate recommended management is needle decompression (ND), followed by the insertion of an intercostal chest drain. The European Trauma Course (ETC) and the Advanced Trauma Life Support (ATLS) guidelines differ on needle size and decompression site, creating clinical uncertainty. This meta-analysis aims to explore the optimal approach for emergency needle decompression in TP.

Methods

This meta-analysis followed the PRISMA 2020 guidelines. It included English-language RCTs, cohort, case–control, cross-sectional studies, and case series with more than six patients. Studies on adults undergoing needle decompression therapy for TP or with chest wall thickness measurements were included. Ovid MEDLINE, Embase, and Web of Science databases were searched until May 31, 2024. Data were extracted, assessed for quality using OCEBM and GRADE, and analyzed using SPSS and OpenMeta with random-effects models. Primary outcome: needle decompression failure rate. Secondary outcomes: patient demographics, cannula size, and chest wall thickness comparisons.

Results

This review analyzed 51 studies on needle decompression for TP, with a weighted mean patient age of 36.67 years. Radiological data from 24 studies (n = 8046) indicated a 32.84% failure rate for needle penetration into the pleural cavity (I²: 99.72%). Increased needle length reduced failure rates by 7.76% per cm. No significant differences in chest wall thickness between genders were observed (T-test, p = 0.77), but thickness at the 5th anterior axillary line (5AAL) and 5th midaxillary line (5MAL) was less than at the 2nd midclavicular line (2MCL). Injury rates were higher at 5AAL than 5MAL, with strong positive correlations between needle length and injury at these sites (0.88, 0.91).

Conclusion

Based on our meta-analysis, a 7 cm needle may be appropriate for decompression of right-sided tension pneumothorax at either the 5th intercostal space along the midaxillary line or the 2nd intercostal space along the midclavicular line. For left-sided cases, given the potential risk of cardiac injury, the 2nd midclavicular line is a safer option. However, these recommendations should be interpreted with caution due to considerable heterogeneity among the included studies, potential risk of bias, and variability in measurement techniques. Clinical decisions should always be individualized, taking into account patient-specific factors.