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]?
You are the doctor on-scence of a road accident attending a 30 year old male who has sustained blunt trauma to the abdomen. Systolic BP is 70 mm Hg despite resuscitation. Someone suggests using the pneumatic antishock garment (PASG). You cannot remember from your recent ALSG 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.
Medline 1966-12/00 using 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.
68 papers were found of which 66 were irrelevant or of insufficient quality. Both of the 2 relevant papers had been meta-analysed by the Cochrane Injuries Group.
|Author, date and country
||Study type (level of evidence)
|Dickinson K and Roberts I,|
|2 prospective randomised controlled trials including 1202 patients
Adults >15 years with blunt or penetrating injuries and a systolic BP <90mmHg. Patients excluded where PASG was only used for fracture splinting.
PASG vs no PASG||Meta-analysis||Length of hospital stay||No reduction in length of hospital stay||Poor quality allocation concealment in both trials
Loss of 14% of patients from one trial with disparity in the two groups|
|Length of time spent in ICU||No reduction in length of time spent in ICU|
|Overall mortality||Pooled relative risk of mortality for patients randomised to PASG group was 1.13 (95% CI 0.97-1.32)|
The use of PASG may actually be associated with an increase in overall mortality in hypotensive patients following 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.
- Dickinson K, Roberts I. Medical anti-shock trousers (pneumatic anti-shock garments) for circulatory support in patients with trauma (Cochrane Review). The Cochrane Library Issue 1, 2000. Oxford: Update Software.