Noncompressible Torso Hemorrhage: A Review with Contemporary Definitions and Management Strategies

KEY POINTS Vascular disruption with concomitant hemorrhage is the leading cause of potentially preventable death in both civilian and military trauma. If this occurs in the torso or in a junctional area, it is termed noncomressible torso hemorrhage NCTH. Although the concept of NCTH is intuitive, there remains no formal definition by which to characterize the scope of the problem and compare interventions. A novel and inclusive definition using anatomic, physiologic, and procedural criteria enables the identification of patients with NCTH. Management requires rapid intervention including damage-control resuscitation and surgery with an emphasis on early hemostasis. Despite the emergence of new strategies such as damage-control resuscitation and adjuncts such as endovascular surgery, the principles of proximal and distal vascular control are essential.