Between Hemorrhage and Harm: Complications of the Abdominal Aortic and Junctional Tourniquet-Stabilized

Hemorrhage is a leading cause of preventable death after trauma, with direct pressure, appropriate tourniquet application, and volume resuscitation established as principles of hemorrhage management. In recent years, several junctional tourniquet devices have been proposed as adjuncts for groin and axillary hemorrhage control, including the Abdominal Aortic Junctional Tourniquet-Stabilized (AAJT-S), which has been marketed for non-compressible torso hemorrhage. To date, evidence supporting its use has been primarily limited to studies on cadavers, porcine models, healthy human subjects, and a few case reports. We present the case of a young adult male with multiple gunshot wounds to the pelvis and lower extremities who presented to a level I trauma center with an AAJT-S in place. Device removal in the trauma bay was followed by cardiac arrest and subsequent complications to include metabolic acidosis, compartment syndrome, rhabdomyolysis, renal and liver infarcts, pulmonary emboli, and stroke. This case highlights the potential harm of the device. We review and contrast these outcomes with the limited available literature and present our recommendation for future evaluation and caution with application of this device.