US Army Institute of Surgical Research, Fort Sam Houston, Texas, USA.
J Trauma Acute Care Surg. 2013 May;74(5):1260-5. doi: 10.1097/TA.0b013e31828cc983.
Junctional wounds and associated hemorrhage have become more common and more lethal in the current war. The Combat Ready Clamp (CRoC) has been developed and deployed for treating junctional hemorrhage on the battlefield. This study examined the efficacy of CRoC and its acute effects in an animal model.
Anesthetized pigs (n = 6) were subjected to laparotomy, splenectomy, and abdominal closure. Next, coagulopathy was induced in animals by hemodilution and hypothermia. The left femoral artery was isolated, punctured (6-mm hole), and allowed to bleed for 15 seconds. The groin wound was packed with gauze, and a CRoC applied and tightened until hemorrhage stopped. It was kept in place for 1 hour (treatment period) and then released for another hour or less (control-period) if animal exsanguinated. Fluid resuscitation was administered, and vascular blood flow was examined by Doppler and CT scans. After death, local tissues were collected for histology.
CRoC generated 800 to 900 mm Hg pressure on the wounds, which stopped the hemorrhage and prevented rebleeding during the first hour in all animals. Blood loss was minimal (≤137 mL), and mean arterial pressure remained at or higher than the target level (65 mm Hg) during this period. Removal of the clamp promptly led to rebleeding and exsanguination of five of six pigs during the second hour despite fluid resuscitation. Blood loss, survival, shock indices, and other measures were significantly (p < 0.01) different between the two periods. Doppler tests and CT scans showed no blood flow in the proximal, distal, and collateral arteries of the clamped leg. Minor inflammation was seen on blood vessels (endothelium) and nerves.
CRoC functioned as an effective hemostatic adjunct for compression and control of groin hemorrhage. Although no acute histological damages were seen in compressed tissues, the short- and long-term effects of CRoC application (e.g., total ischemia) on limb function remain unknown and warrant investigation.
在当前战争中，交界性伤口和相关出血变得更加常见和致命。战斗准备夹（CRoC）已经被开发和部署用于治疗战场上的交界性出血。本研究在动物模型中检查了 CRoC 的疗效及其急性影响。
麻醉猪（n = 6）进行剖腹术、脾切除术和腹部闭合术。接下来，通过血液稀释和低温诱导动物发生凝血功能障碍。分离左股动脉，穿刺（6 毫米孔），让其出血 15 秒。用纱布填塞腹股沟伤口，应用 CRoC 并拧紧，直到出血停止。保持 1 小时（治疗期），如果动物失血过多，则在 1 小时或更短时间内释放（对照期）。进行液体复苏，并通过多普勒和 CT 扫描检查血管血流。死亡后，收集局部组织进行组织学检查。
CRoC 在伤口上产生 800 至 900 毫米汞柱的压力，在所有动物中，在第一个小时内止血并防止再出血。失血量最小（≤137 毫升），在此期间平均动脉压保持在或高于目标水平（65 毫米汞柱）。尽管进行了液体复苏，但在第二个小时，夹闭夹迅速去除导致五头六头猪再次出血和失血过多。夹闭期间的失血量、存活率、休克指数和其他措施在两个时期之间存在显著差异（p < 0.01）。多普勒测试和 CT 扫描显示夹闭腿的近端、远端和侧支动脉均无血流。血管（内皮）和神经有轻微炎症。
CRoC 作为一种有效的压迫止血辅助工具，可用于控制腹股沟出血。尽管受压组织未见急性组织学损伤，但 CRoC 应用的短期和长期影响（例如，完全缺血）对肢体功能的影响仍不清楚，需要进一步研究。
