PowerPoint Presentation

NASG: Updates on Clinical Trial Results, Cost Effectiveness, and Global GuidelinesProfessor Suellen MillerUniversity of California, San FranciscoDept. Obs/Gyn & Reproductive SciencesDirector, Safe Motherhood Program

What is the NASG?

Mechanism of Action Circumferential compression of the abdomen and legs reduces the volume of blood in the compressed areas, while expanding the central circulation, reversing shockThe radius of a blood vessel is decreased, blood flow is decreasedDECOMPENSATORY SHOCK: the heart, lungs and brain are deprived of oxygen as blood accumulates in the lower part of the body

OBSTETRIC HEMORRHAGE: blood also leaves the body through the vagina or pools in the retroperitoneal areaCircumferential compression of the abdomen and legs reduces total vascular volume while expanding the central circulation, where the oxygen-dependent tissues of the Heart Lung and from the lower extremities and abdomen to the heart, brain, lungs

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NASGs Unique Role in Obstetric Hemorrhage and Hypovolemic ShockUsed with hemorrhage therapies, uterotonics, massage, vaginal procedures, even surgeriesDoes not compete with other approaches: Not an either or situation, first-aid device that buys timeA technology that can be used when patient with uterine atony does not respond to uterotonicsANDEffective for ALL obstetric hemorrhage: rupture, lacerations, ectopicOnly technology that reverses shock, until blood transfusionsCan be used with balloon tamponade to reverse shock

4Countries Using NASGs

Clinical Trials: Tertiary Level5 peer-reviewed studies: 4 pre-post design, 1 (India) contemporaneous use3,651 women: Severe OH (>1000 mL) with clinical sxs of shock1614 (45.3%), standard care, 1947, 54.7% standard care + NASGSub-analysis of Severe Shock (1227 MAP < 60 mm HG, 594, std care; 633, 51.6% std care + NASG)Meta-analytic Techniques to pool all data

1614 (45.3%) standard care plus NASG 1947 (54.7%) standard care only

1227 women with MAP$10,000)Decreased Costs in Nigeria, $1.78/DALY averted

WHO calls any intervention that reduces DALY at < = GDP is highly cost effectiveHemorrhage Etiologies: UCSFWHO, FIGO, GLOWM RecommendationsBased on safety, decreased blood loss, reduced time to shock recovery, and decreased mortalityWHO: 2012, Guidelines and 2013, HighlightsExamine national guidelines to ensure NASG includedExamine training curricula to ensure providers trained in NASG use (pre-service and in-service)Procure NASGsFIGO, 2012: Use of NASG as life-saving tool in hypovolemic shock to survive delays GLOWM, 2012: keep woman in shock stable during transport

UNFPAKate Gilmore modelled the NASG during a press conference at Women Deliver on ThursdayHope to get into kits if appropriate

WHO and UCSFWorking on training materials for humanitarian settings

THANK YOU