A Randomized Controlled Trial using iTClamp, Direct Pressure, and Balloon Catheter Tamponade to Control Neck Hemorrhage in a Perfused Human Cadaver Model

• Published in: The Journal of emergency medicine Vol. 56; no. 4; pp. 363 - 370
• Main Authors: Mckee, Jessica L., Mckee, Ian A., Bouclin, Melanie D., Filips, Dennis F., Atkinson, Ian J., Ball, Chad G., McBeth, Paul B., Kirkpatrick, Major Andrew W.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2019
• Subjects: hemorrhage; hemorrhage control; neck hemorrhage; penetrating neck injury; neck hemorrhage; hemorrhage control; penetrating neck injury; hemorrhage
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2018.12.008

Penetrating neck wounds are common in the civilian and military realms. Whether high or low velocity, they carry a substantial morbidity and mortality rate. We endeavored to ascertain whether the iTClamp is equivalent to direct manual pressure (DMP) and Foley catheter balloon tamponade (BCT). Using a perfused cadaver, a 4.5-cm wound was made in Zone 2 of the neck with a 1-cm carotid arteriotomy. Each of the hemorrhage control modalities was randomized and then applied to the wound separately. Time to apply the device and fluid loss with and without neck motion was recorded. There was no significant difference between the fluid loss/no movement (p > 0.450) and fluid loss/movement (p > 0.215) between BCT and iTClamp. There was significantly more fluid lost with DMP than iTClamp with no movement (p > 0.000) and movement (p > 0.000). The iTClamp was also significantly faster to apply than the Foley (p > 0.000). The iTClamp and BCT were associated with significantly less fluid loss than DMP in a perfused cadaver model. The iTClamp required significantly less time to apply than the BCT. Both the iTClamp and the BCT were more effective than simple DMP. The iTClamp offers an additional option for managing hard-to-control bleeding in the neck.