Tag Archives: MAST trousers

Equipment, Prehospital

The Rise And Fall Of MAST Trousers

1 Comment

Remember MAST Trousers (Military Anti-Shock Trousers)? They were a staple of prehospital care starting in the 1970s and lasting through the turn of the century. But what happened after that? They seem to have disappeared. I recently received a question on the topic recently and wanted to share the real story with you readers.

The basic MAST trouser consists of three inflatable compartments: two legs and one covering the abdomen and pelvis. Each can be inflated or deflated separately. The basic concept was first described by a surgeon who wanted to increase blood pressure during neurosurgical procedures in the early 1900s. The US military embraced the concept during the Vietnam war, using it to augment systolic pressure in servicemen in shock.

Military surgeons migrated this device into civilian prehospital care during the mid-1970s, and the American College of Surgeons Committee on Trauma listed this device as essential on all ambulances in 1977. MAST trousers then came into widespread use throughout the 1980s and 1990s.

Early research in the 1970s suggested that this device could provide up to a 20% boost in volume to the upper part of the body when applied. But as occurs with so many new toys, additional research demonstrated that this auto-transfusion effect was actually only about 5% of blood volume. Some significant complications also came to light as lower extremity ischemia and compartment syndromes were described. Ben Taub Hospital published a study in 1987 which showed no improvement in mortality in patients with penetrating injury.

At the end of the century, support for MAST started to dry up. The NAEMSP published a position paper limiting use to ruptured abdominal aortic aneurysms and pelvic fractures with hypotension. The final straw was a review by the Cochrane Collaboration in 2000 that confirmed no reduction in mortality with MAST use.

Although a few older textbooks may still mention MAST trousers, they are no longer the standard of care. There are no longer any accepted indications for their use, and the few trousers that remain are gathering cobwebs in some corner of the trauma basement.

Reference: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.

General

A Tourniquet For Your Abdomen???

Leave a comment

Tourniquets for extremity bleeding are definitely back in vogue. Our military experience over the past 20 years has shown us what a life saver this simple tool can be. It’s now carried by many prehospital trauma professionals for use in the civilian population. But what about bleeding from the nether regions? You know what I’m talking about, the so-called junctional zones. Those are the areas that are too proximal (or too dangerous) to put on a tourniquet, like the groin, perineum, axilla, and neck.

Traditionally, junctional zone injury could only be treated in the field with direct pressure, clamps, or in some cases a balloon (think 30Fr Foley catheter inserted and blown up as large as possible, see link below). In the old days, we could try blowing up the MAST trousers to try to get a little control, but those are getting hard to find. 

An Alabama company (Compression Works) developed a very novel concept to try to help, the Abdominal Aortic and Junctional Tourniquet (AAJT). Think of it as a pelvic compression device that you purposely apply too high.

image

Note the cool warning sticker at the bottom of the device!

The developers performed a small trial on 16 volunteer soldiers after doing a preliminary test on themselves (!). The device was placed around the abdomen, above the pelvis, and inflated to a maximum of 250 torr. Here are the factoids:

  • All subjects tolerated the device, and no complications occurred
  • Flow through the common femoral artery stopped in 15 of the 16 subjects
  • The subject in whom it did not work exceeded the BMI and abdominal girth parameters of the device
  • Average pain score after application was 6-7 (i.e. hurts like hell!)

Here’s a list of the criteria that preclude use of this device:

image

Bottom line: This would seem to be a very useful device for controlling hemorrhage from pesky areas below the waist.

BUT! Realistically, it will enjoy only limited use in the civilian population for now. Take a closer look at the exclusion criteria above. Half of the population is ineligible right off the bat (women). And among civilians, more than a third are obese in the US. Toss in a smattering of the other criteria, and the unlikelihood of penetrating trauma to that area in civilians, it won’t make financial sense for your average prehospital agency to carry it. Maybe in high violence urban areas, but not anywhere else.

The company has received approval for use in pelvic and axillary hemorrhage control, so we’ll see how it works when more and larger studies are released (on more and larger people). 

Related post:

Reference: The evaluation of an abdominal aortic tourniquet for the control of pelvic and lower abdominal hemorrhage. Military Med 178(11):1196-1201, 2013.

I have no financial interest in Compression Works.