Auto-Transfusion Tourniquet (A-TT) Reanimation of Cardiac Arrest Patients-A Retrospective Chart Review

Out-of-hospital cardiac arrest (CA) with CPR has poor outcomes. We report our experience with 17 patients admitted to the Eisenhower Emergency Department (ED) in Rancho Mirage, CA, who underwent treatment with a novel autotransfusion tourniquet (A-TT, Oneg HaKarmel, Israel). Methods: The Eisenhower IRB authorized this report. All patients were in terminal arrest after receiving CPR throughout the 22-56 minutes of transport to the ED. One or both legs received the A-TT upon arrival at the ED. This study is derived from a retrospective analysis of emergency department medical records. Results: Seven patients were removed because (a) the collapse was unwitnessed (two patients), (b) non-cardiac etiology (four patients), or (c) improper use of A-TT (one patient). The collapse of the remaining 10 patients was witnessed and attributed to cardiac causes. Seven of these 10 individuals had ROSC within 1-5 minutes following the A-TT application. Five ROSC patients were transferred to the ICU, and one was released neurologically intact. Discussion: As a “mechanical vasoconstrictor,” the A-TT sends blood from the legs to the core and prevents the blood from returning. This directs CPR cardiac output to the vital organs. The rate of return of spontaneous circulation (ROSC) in this small cohort is higher than expected, considering the significant time elapsed since the onset of cardiac arrest. Conclusion: Mechanical distal-to-proximal shifting of the legs’ blood by the A-TT has the potential to improve the rate of ROSC when applied together with standard CPR. Earlier use of A-TT may lead to a better outcome.