Table 1

Abdominal aortic junctional tourniquet-stabilised systematic review animal studies

Study	Model	Subject (n)	Intervention	Comparator	Further intervention	Flow occlusion	Effectiveness	Complications
Bonanno et al 18	80% laparoscopic, left-side liver lobe transection	24	At 10 min AAJT applied and inflated to 40 mm Hg. At 20 min deflated	Two boluses of 500 mL Hextend	Both groups received damage control surgery at 60 min and up to 3 L whole blood resuscitation	Not reported	No significant physiological differences seen No mortality difference seen	3 AAJT and 2 control had vena cava thrombus
Do et al 21	Open book pelvic fracture and major iliac vessel injury	32	MAP of 40 triggered device implementation Tightened to pressure of 250 mm Hg Applied for 60 min	Open packing Preperitoneal balloon tamponade No treatment		Significantly lower bleed rate	4.7 min survival with no treatment 60 min survival AAJT 41 min survival open packing 60 min survival preperitoneal balloon tamponade	Higher lactate Acidotic AAJT sustained 50% bladder/bowel injury compared with 0% in other groups
Rall et al 12	40% blood volume loss, 15 min before intervention	40	AAJT inflated to 250 mm Hg 120 min application time	Two 500 mL Hextend boluses	All animals mechanically ventilated	Occluded flow	Significantly improved MAP and systemic vascular resistance (afterload)	No complications seen Significantly higher lactate
Kheirabadi et al 13	25% blood volume loss from groin	18	120 min application time, mechanically ventilated	Spontaneously breathing	Spontaneously breathing on application, then transitioned to mechanical ventilation	Controlled bleeding	Raised BP and HR Maintained survival for 120 min Ventilation not affected when AAJT in place Significant effects seen after removal	All spontaneously breathing swine suffered respiratory arrest; 50% died within 45 min D-dimer increased×10 Ischaemia reperfusion fatal in spontaneously breathing Increased CK and AST
Brännström et al 20	900 mL blood volume loss	15	60 min application	240 min application No application		Occluded flow	Reperfusion consequences possible at 60 min Compression occurred below renal vessels so kidneys remain perfused	Reperfusion consequences irreversible at 240 min. Small intestine and liver ischaemia, ureteric compression causing hydronephrosis Hyperkalaemia and metabolic acidosis
Kheirabadi et al 13	40% blood volume loss from bilateral femoral artery laceration	17	AAJT at 300 mm Hg for 60 min	No AAJT—femoral vessels clamped 90 min 120 min	500 mL Hextend given to some to improve MAP	Occluded in all	Restored MAP and stopped bleeding AAJT can be used for 60 min without long-term damage Reperfusion metabolites returned to baseline in <90 min swine	Control animals walked normally on day 1 60 min swine walked normally at day 7 50% of 90 min swine walked normally at day 14—remaining 50% euthanised 100% of 120 min swine euthanised due to compression injury of spastic paraplegia Widespread deep skeletal muscle necrosis
Schechtman et al 19	Femoral fracture and 40% blood loss	20	AAJT 60 min	Zone 3 REBOA	Resuscitated with 15 mL/kg whole blood and observed for 6 hours	Haemostasis achieved. Both groups equivocal	Improved MAP Lactate equal	Both groups had one fatality AAJT 100 min REBOA 287 min MAP decreased significantly lower following removal of AAJT cf REBOA

AAJT, abdominal aortic junctional tourniquet (Food and Drug Administration-approved 2013); AST, aspartate transaminase; CK, creatine kinase; MAP, mean arterial pressure; REBOA, resuscitative endovascular occlusion of the aorta.