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Best evidence topic report
The prehospital use of pneumatic anti-shock garments
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  1. Ian Crawford,
  2. Angaj Ghosh
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
  1. Correspondence to: Kevin Mackway-Jones, Consultant (kevin.mackway-jones{at}man.ac.uk)

http://dx.doi.org/10.1136/emj.18.4.274

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    Report by Ian Crawford, Clinical Research Fellow Search checked by Angaj Ghosh Senior Clinical Fellow

    Clinical scenario

    You are the doctor on scene of a road traffic accident attending a 30 year old man who has sustained blunt trauma to the abdomen. Systolic BP is 70 mm Hg despite resuscitation. Someone suggests using the pneumatic anti-shock garment (PASG). You cannot remember from your recent ATLS course whether this can be used to support blood pressure in hypotensive patients. You wonder if PASG use has been shown to have any effect on mortality.

    Three part question

    In [a hypotensive trauma victim] does [the use of PASG/MAST] reduce [mortality, length of hospital stay or length of time spent in ICU]?

    Search strategy

    Medline 1966–12/00 using the OVID interface AND cochrane database. {[(exp g suits OR g suit.mp OR pneumatic antishock garment.mp OR military antishock trouser$.mp OR PASG.mp OR MAST suit.mp) AND (exp wounds and injuries OR trauma$.mp) AND maximally sensitive RCT filter]} LIMIT to human AND english.

    Search outcome

    Altogether 68 papers were found of which 66 were irrelevent. Both of the two relevant papers had been meta-analysed by the Cochrane Injuries Group (table 6).

    View this table:
    Table 6

    Comments

    The use of PASG may actually be associated with an increase in overall mortality in hypotensive patients after trauma. In addition, no reduction was demonstrated in length of hospital stay or length of time spent in ICU.

    Clinical bottom line

    The use of PASG in hypotensive patients following trauma cannot be supported.

    Report by Ian Crawford, Clinical Research Fellow Search checked by Angaj Ghosh Senior Clinical Fellow

    References

    1. Dickinson K, Roberts I. Medical anti-shock trousers (pneumatic anti-shock garments) for circulatory support in patients with trauma (Cochrane Review). In: The Cochrane Library. Issue 1, 2001. Oxford: Update Software.