Color and pulsed Doppler sonography for arterial bleeding detection.

Objective: Hemorrhage resulting from penetrating injuries in the extremities is the leading cause of preventable death in the modern battlefield. Development of methods for detection and localization of vascular bleeding is needed that could be applied emergently without special training outside the hospital setting. Our objective was to assess whether Doppler sonography can provide quantitative parameters that characterize the bleeding site in the extremities.

Methods: Twenty-four rabbit femoral arteries (diameter of approximately 1 mm) were punctured transcutaneously with an 18-gauge needle. Doppler interrogations were performed at 5 locations in the injured vessels (site of injury, distal and proximal locations relative to the injury, and neck and tip of the bleeding jet).

Results: Compared with the normal signals obtained before the vessel was punctured, pulsed Doppler observations of the injury site showed a statistically significant increase in the systolic and diastolic velocities (systolic: mean +/- SD, 30.1 +/- 12.5 cm/s [injury] versus 15.1 +/- 4.2 cm/s [normal]; diastolic: 17.8 +/- 6.5 cm/s [injury] versus 0.7 cm/s [normal]). Similar increases in velocities were observed at the neck of the bleeding jet, whereas the tip of the bleeding jet showed venouslike patterns. These patterns are unique only at the bleeding site. Color Doppler observations showed turbulence (in the form of checkered color patterns) localized at the injury site.

Conclusions: Our results indicate that both color and pulsed Doppler sonography can be used to accurately localize the site of injury, which may facilitate application of hemorrhage control therapies in battlefield situations.