Pneumatic antishock garments (PASG): do they precipitate lower-extremity compartment syndromes?

Pneumatic antishock garments (PASG) are widely used for treatment of hypovolemic shock and for long-term control of bleeding associated with pelvic fractures. Several cases of compartment syndromes (CS) caused by PASG application, and with sequelae such as limb loss, myoglobinuric renal failure, and death have been reported. The aim of this study was to investigate the amount of PASG pressure needed to produce tissue anoxia. Twelve normotensive subjects were investigated, and transcutaneous oxygen tension (TcPO2) was measured beneath a full-length pneumatic splint at the following pressures applied: 0, 10, 15, 20, 25, 30, and 35 mm Hg. Without imposed pressure, mean TcPO2 was 70.6 mm Hg. TcPO2 decreased by increasing pneumatic pressure, expressed by the equation: TcPO2 = 2.3x + 65.7, where x is applied pressure in mm Hg. TcPO2 became zero at a mean applied pressure of 28 mm Hg (25-35). It is concluded that PASG pressures of 30 mm Hg or more applied to the whole limb stop microcirculation and result in tissue anoxia. Even low PASG pressures carry a high risk of precipitating CS. To avoid ischemic injury new guidelines for PASG application are discussed.