196 A Simple Abdominal Tourniquet for Pelvic and Junctional Hemorrhage

Abdominal tourniquets are used to treat critical, otherwise uncontrollable bleeding from the pelvis, pelvic organs and lower extremity junctional sites (those too close to the pelvis to allow for peripheral tourniquet placement). They are used primarily for traumatic injuries but have also been suggested for obstetrical hemorrhage. Commercial devices are relatively expensive and unavailable in low resource countries. The objective of this study was to develop and test a low cost abdominal tourniquet that could be made on-site using locally available supplies. An abdominal tourniquet was made by placing an uninflated standard size 5 soccer ball on the subject’s abdomen, wrapping it tightly with a 12-inch wide sturdy cloth binder and securing the binder with sewn-on hook and loop (eg, Velcro) strips. A comparative trial using this device was done in 12 healthy volunteers. The ball was gradually inflated using a hand pump. The internal ball pressure was measured during inflation while distal aortic blood flow was monitored just below the superior mesenteric (SMA) takeoff using a GE VolusonTM ultrasound. When blood flow stopped the ball pressure was recorded. The subject was then asked how painful the procedure was, using a 10-point scale where 1 equaled no pain and 10 equaled the most pain tolerable. The ball was then deflated. The study was approved by the University of New Mexico Institutional Review Board. The mean pressure to completely stop distal aortic flow was 150 mmHg (95% CI 130 - 170mmHg). The mean pain score was 4.5 (95% CI 3.4-5.6). This abdominal tourniquet was able to completely stop blood flow to the pelvis and lower extremities. It was only moderately painful.