Failure of cross clamping the thoracic aorta to control intra-abdominal bleeding

The efficiency of cross clamping the thoracic aorta for cases of massive hemorrhage and impending cardiac arrest is questionable. We present two cases of major intra-abdominal aortic injury in which the bleeding could not be controlled by cross clamping the thoracic aorta. Multiple collateral pathways around the clamped aorta may have rendered this procedure almost ineffective. In cases of major intra-abdominal arterial disruption, emergency department laparotomy may be necessary.