Bleeding control in catastrophic blunt pelvic trauma using the abdominal aortic and junctional tourniquet in a civilian level I trauma center - A case report

Sep 30, 2026

Uploaded by dhado

Non-compressible blunt pelvic trauma with hemodynamic instability often leaves few prehospital or emergency options for rapid bleeding control. This case report evaluates external abdominal aortic and junctional tourniquet (AAJT) use as an alternative to resuscitative endovascular balloon occlusion of the aorta (REBOA). A 27-year-old patient with intrapelvic hemorrhagic shock received temporary AAJT control in the emergency bay, followed by definitive control after imaging and improved vital signs.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages5

Reading Time13 min

AccessFree to download

Abstract

Background

Case presentation

Conclusions

Keywords

Case presentation

Prehospital assessment and treatment

Background

Honnef etal. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine (2026) 34:2 [https://doi.org/10.1186/s13049-025-01517-w](https://doi.org/10.1186/s13049-025-01517-w) Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine CASE REPORT Open Access Bleeding control in catastrophic blunt pelvic trauma using the abdominal aortic and junctional tourniquet in a civilian level I trauma center: A case report Gabriel Honnef1, Daniel Freidorfer 1*, Paul Puchwein2, Jakob Steiner3 and Philipp Zoidl 1 Abstract Background In non-compressible blunt pelvic trauma with hemodynamic instability there are few options to ensure bleeding control in the prehospital setting or the emergency bay. These include insertion of a balloon into the descending aorta to achieve occlusion and loss of blood flow distal to the device known as resuscitative endovascular balloon occlusion of the aorta (REBOA). An alternative is the use of an external abdominal aortic and junctional tourniquet (AAJT) which is inflated to produce compression of the aorta. Case presentation We present the case of a 27-year-old patient, who was transferred to our emergency department by local emergency medical service after a fall from ten meters height onto concrete. The patient presented in hemorrhagic shock due to intrapelvic bleeding. Temporary bleeding control using the AAJT was initiated in the emergency bay, and after initial imaging, the patient was taken to the operating theatre for definitive bleeding control with improved vital signs following tourniquet inflation. Conclusions This case report suggests, that the use of the AAJT in civilian setting is feasible and could act as an alternative to other methods of temporary pelvic bleeding control, including invasive procedures like the REBOA. | The authors declare: that the article is the authors original work, the article has not received prior publication and is not under consideration for publication elsewhere, that all authors have seen and approved the manuscript being submitted, the authors abide by the copyright terms and conditions of Annals of Emergency Medicine. | | --- | | No author has a conflict of interest to declare. There has been no funding for this academic work. | | The patient has been included in a prospective observational study (NCT06622317 – ethic committee approval 1063/2024 Medical University of Graz) and has provided written consent for the use of her anonymized data. | *Correspondence: Daniel Freidorfer [daniel.freidorfer@medunigraz.at](daniel.freidorfer@medunigraz.at) Full list of author information is available at the end of the article Background Traumatic pelvic fractures are associated with high morbidity and mortality due to the potential for massive hemorrhage from venous plexuses and arterial injury. Managing hemorrhagic shock in such patients requires rapid resuscitation, including initial haemorrhage control, volume replacement, and definitive surgical or interventional radiologic bleeding control. The first study of the AAJT, which was originally developed for military use to control junctional and pelvic bleeding in environments where surgical resources are limited, was published in 2009 in Georgia [1]. © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is

FAQs

What problem does the report address in blunt pelvic trauma?

Non-compressible blunt pelvic trauma with hemodynamic instability can make it difficult to ensure rapid bleeding control in prehospital or emergency settings.

How was AAJT used in this case?

Temporary bleeding control was initiated in the emergency bay with an external abdominal aortic and junctional tourniquet, followed by definitive bleeding control after initial imaging and tourniquet inflation.

What does the report conclude about AAJT in civilian practice?

The case report suggests that AAJT use in a civilian setting is feasible and may serve as an alternative to other temporary pelvic bleeding control methods, including REBOA.

Sep 30, 2026

Uploaded by dhado