Technique of Axillary Use of a Combat Ready Clamp to Stop Junctional Bleeding

Junctional body regions are too proximal for a regular limb tourniquet to fit and include the groin and axillary areas 1,2. Recently, we described a technique of the use of the Combat Ready Clamp Combat Medical Systems, Fayetteville, NC in prehospital hemorrhage control and a cadaver model used in its regulatory approval, but such uses were only in the groin 3-5. Uncontrolled upper extremity hemorrhage in war is common, disabling, and lethal recently, we counted 833 US military casualties hospitalized with a junctional wound coded during the current wars. Of the 151 casualties with an upper extremity injury amenable to a Combat Ready Clamp in axillary use, 16.6 died of wounds 25151 Kragh et al, unpublished data. To show users how to apply a Combat Ready Clamp to stop axillary bleeding, we illustrate its technique of use. To help users understand the devices efficacy, we report data used in its regulatory application. To test efficacy, we used Wake Forest University Medical Centers cadaver hemorrhage control model but instead of groin bleeding, we modeled axillary bleeding in a protocol approved by the Wake Forest institutional review board 4. After the donor bequeathed the body under ethical oversight of the School of Medicine, a male cadaver was used age, 75 years weight, 150 lb. The body was refrigerated until used on May 18, 2012. The right subclavian artery was cannulated with pump tubing. Water simulated blood flow at 500 mLmin at 56 beatsmin Watson-Marlow pump model 603S issue 1 Bacon Technical Industries, Inc, Concord, MA. The axillary artery was isolated in the axilla, transected, and clamped with a hemostat in between iterations of Clamp use. The artery lumen bleeding was seen before, during, and after device use. Users target the underlying axillary artery in the deltopectoral groove where soldiers nestle rifle butts when shooting of the abducted arm Fig. 1.