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Abstract

Thank you for your interest in our review article. In principle, we agree that external aortic compression may have clinical benefits for a patient in shock. A favorite quote in the literature on aortic compression was from an unknown correspondent to the editor of the journal “The Hospital” in 1911: “The attendant compresses the aorta, just below the umbilicus and before its bifurcation, with either his finger and thumb, or the first and second fingers. By keeping the aorta firmly pressed against the spine the flow of blood can be perfectly regulated. […] I have used this means of compression many times and I have never known it to fail.”1Anonymous Aortic compression. The Hospital.1911: 538Google Scholar Unfortunately, the author did not provide any data to support the claims. However, we can understand that external aortic compression is far from being a new technique. The aforementioned quote was indeed in response to an article on a device, “Momberg’s Belt,” used for treating postpartum hemorrhage. Hauswald and Kerr2Kerr N. Hauswald M. Tamrakar S.R. et al.Obstetric hemorrhage in resource-limited locations: A quality improvement project after adoption of abdominopelvic compression devices.Int J Gynaecol Obstet. 2020; 151: 97-102Crossref Scopus (2) Google Scholar have been producing some interesting work in this area regarding the management of postpartum hemorrhage; unfortunately, however, our search terms and literature review did not catch their research. We did include Soltan’s3Soltan M.H. Imam H.H. Zahran K.A. et al.Assessing changes in flow velocimetry and clinical outcome following use of an external aortic compression device in women with postpartum hemorrhage.Int J Gynaecol Obstet. 2010; 110: 257-261Crossref PubMed Scopus (10) Google Scholar,4Soltan M.H. Faragallah M.F. Mosabah M.H. et al.External aortic compression device: the first aid for postpartum hemorrhage control.J Obstet Gynaecol Res. 2009; 35: 453-458Crossref PubMed Scopus (24) Google Scholar work on an obstetrics service in Egypt that reported some success with a device similar to the Ball and Binder device, although with many confounders. From our recent review, it seems clear that external compression, by a device or manually, will stop distal blood flow in almost all cases. Even in healthy volunteers, distal flow is consistently halted. Logically, it is even more likely to succeed in a hypotensive patient in shock.5Soeyland T. Hollott J.D. Garner A. External aortic compression in noncompressible truncal hemorrhage and traumatic cardiac arrest: a scoping review.Ann Emerg Med. 2022; 79: 297-310Abstract Full Text Full Text PDF Scopus (2) Google Scholar We also agree that external aortic compression for bleeding above the aortic bifurcation is probably not warranted. Our review focused purely on external aortic compression and not on antishock garments. Manual external aortic compression with the fist or knee is certainly very easy to apply, and one could argue about the ease of applying any of the recent devices for external aortic compression versus the older antishock garments. In our view, the real question is whether external aortic compression can improve patient-oriented outcomes. The evidence is not robust. External aortic compression also needs to be explored further regarding adverse effects and how it compares to invasive techniques. We encourage any further research in this area. External Aortic Compression in Noncompressible Truncal Hemorrhage and Traumatic Cardiac Arrest: A Scoping ReviewAnnals of Emergency MedicineVol. 80Issue 2PreviewWe read with interest the review of external aortic compression by Soeyland et al.1 The literature on external devices that compress the aorta, including pneumatic antishock garments, nonpneumatic antishock garments, and our own soccer ball–based Ball and Binder, may help clarify several issues.2 An external pressure that is greater than the pressure in a bleeding vessel will always stop flow and, hence, hemorrhage; this is simple physics. Aortic flow can be stopped completely using a pneumatic antishock garments or Ball and Binder because these devices can generate pressures greater than the aortic pressure. Full-Text PDF