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 aorta compression to achieve a temporarily reduction in bleeding before and during definitive treatment but this is not widely used.
Clinicians about external aortic compression
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.
Professor Emeritus of International Health at Karolinska Institutet in Stockholm, Sweden. He is a gynecologist with extensive experience from working in Africa both as a clinician and a teacher.
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.
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
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
Anaesthesiologist, Sahlgrenska university hospital, Östra, Göteborg Sweden
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.
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 J 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.
Clinicians about ExAC simdoll
Paramedic, Østfold Hospital, Norway
In 2019, 267 women had an unplanned delivery outside of hospitals in Norway. Ambulance personnel are often the first healthcare workers to attend these women, but due to the low frequency of these situations this is not routine for any of us. By training on ExAC simdoll, my colleagues and I have for the first time learned how to recognize an atonic uterus, provide uterus massage and perform external aortic compression. This training has made me as a paramedic more confident in providing adequate care for women giving birth prehospitally. We have also realized the importance of protocols for how to prevent and treat postpartum hemorrhage,
Dr Ronald Tubasiime
Consultant General surgeon
Head of department of surgery
Kibogora District Hospital
At my hospital we have 2750 deliveries every year.The access to blood products is limited and last year 2 women died due to postpartum hemorrhage.
At my hospital a workshop was organized for more than 20 doctors and midwives focusing on the treatment of postpartum hemorrhage. We had a very good experience with training on the ExAC simulation doll. It is really a precious knowledge shared with us. The doll has shown us a possible way of uterine massage and aortic compression and I strongly recommend its promotion to reduce postpartum hemorrhage.
Clinical officer from Kenya. Have been working for the ministry of health in Kenya and for Medecins sans frontieres (MSF) in South Sudan.
In my years of work I have seen several women die of postpartum hemorrhage. I have not performed an aortic compression for the 17 years I have been in the medical profession and my first time to perform it was on the ExAC Trainer
I truly believe that if this procedure is trained to medical workers and more emphasis is put on the use of this maneuver when healthcare workers treat patients with postpartum hemorrhage, many women would be saved from unnecessary deaths.
Midwife with 20 years of experience.
Østfold hospital, Kalnes, Norway
The last few years external aortic compression has been implemented in my hospital as an important maneuver to reduce postpartum hemorrhage.
At major hemorrhages, where uterus massage and medical treatment are not sufficient, external aortic compression is used to reduce blood loss. It is used in the ward or while transporting the patients to the operating theater. External aortic compression can also facilitate while suturing tears in the birth canal as the visibility improves due to reduced bleeding.
The ExAC Trainer has given students, as well as experienced midwifes, the possibility to practice external aortic compression and evaluate the technique. It is highly recommended.