నైరూప్య

The effect of limb elevation on bleeding control in a human venous hemorrhage model.

Du Pont D*, Griesser C , Shofer F , Dickinson E

Background: The use of limb elevation as an adjunct to direct wound pressure for the control of extremity hemorrhage was for many decades a standard part of first aid and prehospital EMS provider training until 2010, when the practice was widely discontinued due to lack of evidence to support the intervention. The purpose of this study was to examine the effectiveness of limb elevation as an intervention to control bleeding. Methods: This was a prospective, randomized, crossover-controlled study. An IV catheter was inserted into the dorsum of the right hand of each volunteer to simulate venous wound hemorrhage. The subjects were randomized to initially bleed in one of two positions: arm elevated or arm dependent. A second determination of blood loss was then made reversing the arm positions from dependent to elevated position or from elevated to dependent position. Each subject’s blood loss in the two positions was quantified and analyzed. Results: 25 adult volunteers were enrolled in the study. One subject was excluded because of an unsuccessful attempt at vein cannulation. The remaining 24 participants underwent successful cannulation of a dorsal hand vein on the first attempt. Participants bled less when the arm was in the elevated position as compared to the blood loss with the arm in a dependent position (0.015 vs. 0.55 grams, respectively, mean difference=0.545, p=0.0002). Only 3 of the 24 (12.5%) participants demonstrated any blood loss in the limb-elevated position (0.1 grams for all 3). There were 2 participants who produced visible blood on the gauze in the down position, and no visible blood on the gauze when allowed to bleed in the elevated position; however, the weight of the blood loss was below the 0.1 gram sensitivity of the scale. Conclusions: The results demonstrate that elevation of an extremity is a simple intervention that reduces venous hemorrhage when compared to a limb that is not elevated. We recommend that wound elevation be reintegrated into standard hemorrhage control educational standards and protocols for first aid and EMS providers