George W. Crile: the pneumatic rubber suit

Area of Science:

• Emergency Medicine
• Medical Devices
• Surgical Innovation

Background:

• The medical use of inflatable compression garments originated in 1903 with George W. Crile's pneumatic rubber suit for augmenting blood pressure during surgery.
• Military antishock trousers (MAST) have been utilized in emergency care for over a decade.
• Early devices faced technical challenges, such as precipitous deflation, but were initially considered to have minimal adverse effects.

Discussion:

• Complications associated with pneumatic garments include reduced vital capacity, metabolic acidosis, skin necrosis, renal failure, vascular thrombosis, and fascial compartment syndrome.
• Despite these potential adverse effects, complications have not occurred frequently enough to significantly limit the use of these devices.
• The precise mechanism by which pneumatic garments elevate blood pressure, initially attributed to increased peripheral resistance, remains an area of ongoing research.

Key Insights:

• Pneumatic compression garments, including MAST, have evolved significantly since their inception.
• While complications exist, their incidence has not historically restricted the clinical application of these devices.
• The physiological mechanism of blood pressure augmentation by these garments requires further investigation.

Outlook:

• Continued research into the mechanism of action for pneumatic compression garments.
• Potential for refining device design to mitigate known complications.
• Further evaluation of MAST and similar devices in diverse clinical settings.