The iTClamp in the treatment of prehospital craniomaxillofacial injury: a case series study

Abstract

Background: Craniomaxillofacial (CMF) injuries are very common in both civilian and military settings. Nearly half of all civilian trauma incidents include a scalp laceration and historical rates of CMF battle injuries increased from 16%-21% to 42.2%. The scalp is highly vascular tissue and uncontrolled bleeding can lead to hypotension, shock and death. Therefore, enabling on-scene providers, both military and civilian, to immediately manage scalp and face lacerations, in a manner that allows them to still function in a tactical way, offers operational advantages. This case series examines how effectively a wound-clamp (iTClamp) controlled bleeding from CMF injuries pre-hospital environment.

Methods: The use of the iTClamp for CMF (scalp and face laceration) was extracted from iTrauma Care's post market surveillance database. Data was reviewed and a descriptive analysis was applied.

Results: 216 civilian cases of iTClamp use were reported to iTrauma Care. Of the 216 cases, 37% (n=80) were for control of CMF hemorrhage (94% scalp and 6% face). Falls (n=24) and MVC (n=25) accounted for 61% of the mechanism of injury. Blunt accounted for 66% (n=53), penetrating 16% (n=13) and unknown 18% (n=14). Adequate hemorrhage control was reported in 87.5% (n=70) of cases, three respondents reported inadequate hemorrhage control and in seven cases hemorrhage control was not reported. Direct pressure and packing was abandoned in favor of the iTClamp in 27.5% (n=22) of cases.

Conclusions: CMF injuries are common in both civilian and military settings. Current options like direct manual pressure (DMP) often do not work well, are formidable to maintain on long transports and Raney clips are a historical suggestion. The iTClamp offers a new option for control of external hemorrhage from open wounds within compressible zones.

Figure 1. Version 2 of the iTClamp is displayed in the image above. This is the current version that is available. In the patient images version 1 of the iTClamp is used. However, the two versions are substantially equivalent and function the same.

Figure 2. Case 1 iTClamp application to the neck. Following a post-operative bleed from the surgical removal of a basal cell carcinoma in the neck.

Figure 3. Case 2: Stab wound to the temporal area This patient was stabbed twice once in the temporal area and once in the neck following an altercation. This image is pre iTClamp application but post gauze application. This image demonstrates the amount of blood loss and wound severity.

Figure 4. Case 2: Scene shot post iTClamp application This is an image of the scene after iTClamp application to the patients temporal region and neck. The bleeding was now under control. It was approximated that the patient lost 1.5 liters of blood on scene from the two stab wounds he sustained.

Figure 5. Case 2: iTClamp application One iTClamp was applied to each of the stab wounds (one to the temporal region and one to the neck) to stop the bleeding. First responders reported no issues with airway management.

Figure 6. Case 3: iTClamp neck application following a self-inflicted injury Post iTClamp application to the neck following a series of self-inflicted injuries. No issues of airway management were reported.