AAJT = REBOA

The Abdominal Aortic and Junctional Tourniquet (AAJT) is equivalent to Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) according to mulitple research papers presented by US Miliatary. The USAF’s 59th Medical Wing and the Institute for Surgical Research (ISR) presented data at the Military Health System Research Symposium (MHSRS) showing equivalency with the application of Zone 3 REBOA.

Resuscitative Endovascular Balloon Occlusion of the Aorta or REBOA is an intervention that has some dramatic physiologic effects in patients experiencing shock. While the full physiologic effects are still being studied, there are some amazing findings being reported. Recently a traumatic arrest from hemorrhage loss was recovered using REBOA. This week military researchers at the Military Health System Research Symposium (MHSRS) presented data that show equivalency between the Abdominal Aortic and Junctional Tourniquet (AAJT) and REBOA.

The significance of this is remarkable. The expense of one of the most popular REBOA kits is just under $2000 and requires a physician to place. It is safest when ultrasound guidance is used. It holds similar risks to a cardiac catheterization. The AAJT costs just over $500 and can be placed by anyone. No knowledge of the anatomy is required nor is any adjunct imaging required. It does not involve any of the invasive risks that REBOA holds. 

REBOA can be life-saving in trauma patients. Now there are data which show an externally applied device, already approved by the FDA, is equivalent to this intervention. It is safe and can be applied by any basic EMT or paramedic. It costs less than a quarter of REBOA. 

Dr. Rall’s research concluded that both the AAJT and Zone 3 REBOA were equivalent in effects on cardiac output, systemic vascular resistance and mean arterial pressure. There were also no differences found in SpO2 and the PaO2/FiO2 ratio. If the two interventions show the same survival, hemostatic, hemodynamic and metabolic profiles as the multiple studies presented showed, why would you not use the lesser invasive, safer, less expensive and quicker alternative? 

Additionally, 3 posters were presented by researchers at the Institute for Surgical Research (ISR) showing that the application of the AAJT held no additional risks of ischemia, systemic metabolic responses, tissue inflammatory responses or end organ effects when compared to REBOA. In essence, the physiological risks of the procedure are the same, while there is inherently less risk in the application of the AAJT to the risks of application of REBOA. 

Another exciting study presented at the Military Health System Research Symposium (MHSRS) in Florida was the use of the AAJT in Cardiopulmonary Resuscitation following Traumatic Cardiac Arrest. Traumatic Cardiac Arrest is a distinctly difficult problem because standard CPR is simply ineffective. The 59th Medical Wing study showed that in a traumatic cardiac arrest model precipitated by Class IV hemorrhage, that remained in arrest for 3 minutes before resuscitation was started, the AAJT improved outcomes. It wasn’t a subtle improvement. A Kaplan-Meier survival analysis showed a greater than 80% survival with the AAJT application. Hemodynamically, carotid blood flow and carotid blood pressure increased with AAJT application.

The AAJT is the only junctional tourniquet to have saved life in upper and lower junctional bleeding. It is the only tourniquet shown to not fail due to collateral flow. It is the only truncal tourniquet approved by the FDA and the only device available approved to externally treat pelvic bleeding. Now its equivalency with REBOA has been demonstrated by multiple independent researchers. It is an intervention that can be safely applied by prehospital providers. 

The AAJT and REBOA equivalency holds exciting new possibilities for treating trauma patients. Now in addition to being known as the best junctional tourniquet and only truncal tourniquet available it may also deserve the name, the Resuscitation Tourniquet?.