Jiu Jitsu Move May Curb Blood Loss After Limb Trauma

By Marilynn Larkin

January 15, 2019

NEW YORK (Reuters Health) - The Brazilian Jiu jitsu knee-mount position can decrease blood flow in major limb arteries and may help control bleeding after injury, according to a small proof-of-concept study.

"The knee mount is a simple maneuver that we feel has potential to be widely used as a bystander intervention for bleeding victims," Dr. Nathan White of the University of Washington School of Medicine in Seattle said by email. "However, there are nuances regarding the correct application of the technique and its proper situational use that still need to be worked out before its widespread dissemination."

When being subdued in a jiu-jitsu class, Dr. White realized that the pressure being applied to his abdomen might decrease blood flow to his legs. The maneuver, used to pin an opponent, is called "knee mount" or "knee ride."

"We are not at the point yet where we would test this on actual victims," he told Reuters Health. "Our planned next steps include refining the technique with expert consensus, including how to best deploy tourniquets from this position, and comparing the knee mount to manual compression with the hands, as it has been taught traditionally, using ultrasound measurements of blood flow in healthy volunteers."

Dr. White and two research associates he trained - a male weighing about 175 pounds and a female weighing about 130 pounds - repeatedly applied the knee-mount maneuver to 11 healthy adults (mean age, 22.5; 82% male). Mean arterial blood velocity (MAV) was measured by ultrasound in the brachial and femoral arteries before and after compression.

The technique was tested in the same order for all subjects, starting at the shoulder, followed by the groin (along the inguinal ligament) and abdomen. A MAV decrease greater than 20% with compression was considered clinically relevant.

As reported online January 5 in Emergency Medicine Journal, the median MAV combining the three locations tested was 29.2 cm/sec at baseline, and decreased to 3.3 cm/sec during compression. Overall, the researchers saw baseline flow decrease by 70%, on average.

Specifically, percent change from baseline blood flow was -97.5% at the brachial artery with shoulder compression and -78% at the femoral artery with groin compression.

The percent change from baseline femoral artery flow with aortic compression was −35%, which was not clinically meaningful.

Complete vessel occlusion was most commonly achieved with brachial compression (73% of the time), followed by femoral artery compression (55%) and aortic compression (9%).

"There is potential to exacerbate pelvic or abdominal bleeding, or to possibly compromise breathing if the technique is not positioned correctly," Dr. White noted. By contrast, "there is minimal risk to the person doing the maneuver. It does not require anything more than a normal degree of flexibility."

"We also feel that there are advantages to situational awareness, since the care provider can maintain a 'heads up' position," he added. "Direct contact with bloody wounds may also be reduced with this position."

Dr. Brian Hiestand, Professor and Vice Chair of Clinical Operations in the Department of Emergency Medicine at Wake Forest School of Medicine in Winston-Salem, North Carolina, commented by email, "The authors do an excellent job outlining the need for bleeding control, and state effectively the current lack of effective solutions for abdominal, groin, and torso/shoulder wounds."

"However, even with the recent interest in the (American College of Surgeons') 'Stop the Bleed' program (https://www.bleedingcontrol.org/) and proliferation of public access hemorrhage control kits, core injuries remain difficult to control," he told Reuters Health. "Direct pressure on the bleeding wound has historically been the recommended option."

"There are arguments to be made for either technique, of course," he said. "If I could control the bleeding with the knee-ride, that would leave my hands free for other tasks. On the other hand (pun fully intended), I have more precise manual control on tasks performed with my fingers and hands than with my knee."

"I would like to see a study utilizing these techniques on simulated patients coated in viscous, slippery gel to simulate the low-traction environment of an actively bleeding wound," he added. "Relying on maintaining pressure and balance with one's body weight sliding on a slick surface might lead to more problems than it solves."

SOURCE: http://bit.ly/2Fq5H7J

Emerg Med J 2019.

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