ExAC’s founder, Grethe Heitmann, has her background as an anesthesiologist. She currently works at one of Norway’s largest hospitals. For years she has had a desire to understand why, and even more importantly, how to help the 300 000 women who die yearly during childbirth.
As a part of her training in obstetric anesthesia, she visited hospitals in both Malawi and Brazil. As a result of this yearning desire to make a difference she founded ExAC in 2019. ExAC aims to specifically empower healthcare workers in their management of large bleedings after delivery (postpartum hemorrhage).
"To save a mother does not only save a life, but also the future of her children."
Postpartum hemorrhage (PPH) is a serious obstetric emergency and is the single most important cause of maternal mortality globally. Research has shown that deaths caused by PPH are preventable if recognized early.
WHO recommends manual aortic compression to achieve a temporarily reduction in bleeding before and during definitive treatment but this is not widely used.
ExAC has developed the manikin ExAC Trainer which makes it possible to learn how to perform external aortic compression. In addition, ExAC develops medical-technical equipment to facilitate and improve the efficacy of the manoeuvre.
Grethe Heitmann
Clinicians about external aortic compression
Ove Karlsson
MD, PhD
Anaestesiologist with obstetric anesthesia as primary interest.
At the University Hospital in Gothenburg we implemented the use of early external aortic compression in cases of major postpartum hemorrhage in 2009. External aortic compression has since then been the primary intervention for bleedings of more than 1 liter or even less if the bleeding is heavy. We apply aortic compression prior to venous access.
We have found that the number of bleedings above 1 liter almost halved from 2007 to 2016 and consequently the need for blood transfusions was reduced by 40%. This change is probably not because of external aortic compression alone, but this simple maneuver was a contributing factor.
Staffan Bergström
MD, PhD
Professor Emeritus of International Health at Karolinska Institutet in Stockholm, Sweden. Gynecologist with extensive experience as a clinician and a teacher in Africa.
Abdominal aortic compression is an important maneuver in situations with major postpartum hemorrhage. Especially in low-income countries, where the access to blood products is limited, this maneuver might save many lives and can easily be taught to different categories of healthcare workers. Abdominal aortic compression allows temporarily bleeding control that makes it possible to for example perform insertion of intrauterine balloon tamponade to achieve permanent hemostasis. It can also be used during transportation to higher level of care and can be maintained for hours.
Elin Erland
Midwife Telemark hospital, Skien, Norway.
Has worked for Medecins sans frontieres (MSF) and Red Cross on missions to South Sudan, India, Sierra Leone and Bangladesh
Niclas Carlberg
Anaesthesiologist, Sahlgrenska university hospital, Östra, Göteborg Sweden
In my 20 years as a midwife, I have experienced several women dying from postpartum hemorrhage, most of them in low resource settings. I believe that a timely external aortic compression maneuver could have made a difference for several of these women. The maneuver can be done by hand alone and the knowledge lies in how to do it and when to use it. Even in extremely challenging settings the knowledge of how to do a timely manual maneuver can save a woman’s life
I remember how much parturient could have bled before arriving in the OR. They could be circulatoric unstable with tachycardia and hypotension. During the last years this has changed, and bleeding parturients are now much more hemodynamically stable. The midwifes have become very quick to apply external aortic compression in the delivery room when they acknowledge abnormal postpartum bleeding. Now the parturient arrive with a midwife sitting in her bed performing external aortic compression.
This increases the safety as we avoid patients who is in circulatory shock when we induce anesthesia.
Maarten Glas
Obstetrician and Gynaecologist
MSF Holland (OCA)
I discovered the logic and feasibility of aorta compression over twenty years ago and have used it countless times. Post partum hemorrhage simply is a compressible bleeding. I have worked in many low income countries with limited means and absent or little access to blood transfusion. It is a true life saver under these conditions.
I often use it from an early stage, when the bleeding is ongoing but the woman is not yet in shock. The easiest way, to my experience, is not to use the fist but rather my two flat hands on top of each other, both with the palms downward. The index and middle finger of the one hand feeling for the aorta and vertebral column, the other hand to help apply enough force to close it off. Of course you find yourself stuck now to the patient and rely on your colleagues to perform all the other tasks like iv lines, catheter, medication, etc. But it puts you in the perfect position to oversee, lead and direct all efforts.
External aortic compression in trauma patients
Matt Douma
Clinical nurse educator at the Royal Alexandra Hospital Emergency Department and an adjunct associate professor of Critical Care Medicine at the University of Alberta.
Matt is a registered nurse and resuscitation scientist who started studying external aortic compression for trauma after responding to a man in the street with multiple gunshot wounds to the abdomen and pelvis. Over the past ten years Matt has led a team in evaluating ways to optimize the maneuver, including during ambulance transport and measuring its effectiveness using ultrasonography.