Vascular Disruption and Noncompressible Torso Hemorrhage

Trauma resulting in hemorrhage from vascular disruption within the torso is a challenging scenario. The source of bleeding may be from structures within the thorax, abdomen, or pelvis and may not be amenable to tourniquet application or manual pressure. As such, this scenario has a propensity to being lethal in the earliest stages after initial trauma. Although the injury pattern and its seriousness are not new, the term "noncompressible torso hemorrhage" was only recently coined as part of contemporary studies describing the epidemiology of wounding during the wars in Afghanistan and Iraq. The burden of injury from these wars and the particular emphasis on the early mortality associated with noncompressible torso hemorrhage have led to a reappraisal of this injury pattern. This chapter provides a contemporary review of noncompressible torso hemorrhage, including a unifying definition to promote future study. Additionally, this appraisal provides a description of resuscitative and operative management strategies that can be utilized in this setting; and it highlights opportunities for additional research that may be required to further mitigate the risk of mortality following this morbid injury pattern.