Pneumatic antisnock garment: state of the art at the turn of the century

Abstract

The pneumatic antishock garment (PASG) accomplishes in 1999 exactly what Crile postulated that it did in 1901. It increases blood pressure by increasing systemic vascular resistance. No published article counters this fact. The weakness that has become apparent is that this increase in blood pressure can also increase haemorrhage and therefore does not necessarily improve outcome in every patient. Patients in profound shock benefit from the reduction in the vascular space and increased systemic vascular resistance, without excessive additional blood loss. Patients without ongoing haemorrhage benefit from increased blood pressure. Patients with ongoing haemorrhage in the abdomen, retroperitoneal area and pelvis benefit as the rate of blood loss is reduced. The controversy that has been sparked by the device is `what is the end point for resuscitation?'. Two randomized studies using the same method for PASG application and large volume replacement of intravenous (iv) fluids has produced the same outcome. One study has been readily accepted while the other has not. If the PASG is bad for resuscitation then so is large volume iv fluid replacement. One cannot accept scientifically or logically one study without accepting the other. The current indications for PASG are haemorrhage control in the abdomen, retroperitoneum and pelvis, and short-term management of profound shock.