Haemorrhage treatment device

Abstract

A compression device (300) for compressing the descending abdominal aorta (160) of a patient. The device (300) has a pressure transfer portion (340) with a smooth external surface (344) and an elastically compliant internal surface (342). The thickness of the pressure transfer portion (340) is between 5mm and 20mm. The compression device (300) has a handle portion (322) connected to the pressure transfer portion (340). In use, an adult hand (400) of a practitioner is accommodated in an opening (360) between the handle portion (322) and the internal surface (342) of the pressure transfer portion (340), and the external surface (344) is in contact with the abdomen (120) of the patient. The practitioner applies a compressive force to the pressure transfer portion (340) by contacting the proximal phalanges (460, 462, 464 and 466) of their hand with the internal surface (342). The external surface (342) exerts a corresponding compressive force on the abdomen (120) of the patient. The compressive force is substantially evenly distributed across the external surface (342) of the device (300).

Description

[0001] Haemorrhage Treatment Device

[0002] BACKGROUND OF THE INVENTION

[0003] This invention relates to a device and method for compression of the descending abdominal aorta. The device is intended for treatment of haemorrhage, such as for women suffering from Post-Partum Haemorrhage (PPH). The device may also be used for other situations where compression of the aorta is required.

[0004] Post-Partum Haemorrhage (PPH) is commonly defined as a cumulative blood loss of more than 500ml or bleeding associated with signs or symptoms of hypovolemia within 24 hours of the delivery. Late or secondary PPH may occur in the first 6 weeks after delivery. The incidence of PPH worldwide is about 5 percent and is a major contributor to maternal mortality.

[0005] The risks associated with PPH are twofold. First, if the loss of blood is not arrested, death will be the final result. Second, severe PPH may lead to organ failure or endocrine dysfunction due to prolonged shock. Hysterectomy may be performed to control bleeding which leads to secondary infertility, and anaemia resulting from PPH weakens the patient, lowers resistance, and predisposes the patient to puerperal infection. Additionally, even when available, blood transfusions give rise to risks of transfusion reactions, and spending of a limited resource.

[0006] Specifically, in the third world and rural areas without easy access to advanced medical treatment facilities, PPH represent a serious risk to the health of the women giving birth. Every year about 14 million women around the world suffer from PPH, and about 70,000 die. The risk of maternal mortality from haemorrhage is high in developing countries.

[0007] The main causes of PPH are a retained placenta, trauma in the birth canal and an atonic uterus. The conventional treatments for PPH include surgery and / or complex medication. For example, the application of an aorta balloon is an established method for the treatment of resistant PPH. However, this is an invasive method performed under sterile conditions requiring trained personnel and carries a risk of complication. This procedure is not suitable for low-income countries due to lack of resources. Neither is it feasible to use in a prehospital setting. In addition to this, the use of an aorta balloon is a time-consuming procedure. In cases of severe PPH, the need for an easy-to-use and non-invasive procedure is therefore of great importance, particularly for low resource settings and pre-hospital in high resource settings.

[0008] The Applicant has appreciated that methods such as manual aortic compression may improve outcomes for patients in these circumstances. Manual aortic compression is a technique that can be applied to reduce bleeding from the uterus and birth canal by reducing the blood supply. External manual compression of the aorta against the spinal column with a fist just above the umbilicus may achieve total arrest in uterine and vaginal blood flow.

[0009] The Applicant seeks to facilitate improvement of the administration of manual aortic compression.

[0010] SUMMARY OF THE INVENTION

[0011] When viewed from a first aspect, the present invention provides a compression device for compressing the descending abdominal aorta of a patient, the device comprising: a pressure transfer portion comprising a substantially smooth external surface and an internal surface opposing the external surface, the pressure transfer portion having a thickness between 5mm and 20mm in a direction extending between the external surface and the internal surface, the internal surface being of an elastically compliant material; and a handle portion connected to the pressure transfer portion, defining an opening between the handle portion and the internal surface of the pressure transfer portion which is dimensioned to accommodate an adult hand of a practitioner; wherein the device is dimensioned such that in use, when the external surface is in contact with the abdomen of the patient and the practitioner applies a compressive force to the pressure transfer portion by contacting a plurality of the proximal phalanges of the practitioner’s hand with the internal surface of the pressure transfer portion, the external surface exerts a corresponding compressive force on the abdomen of the patient which is substantially evenly distributed across the external surface.

[0012] From a further aspect the invention provides a method for operating a compression device for compressing the descending abdominal aorta of a patient by a practitioner, wherein the compression device comprises: a pressure transfer portion comprising an external surface and an internal surface opposing the external surface; and a handle portion connected to the pressure transfer portion, defining an opening between the handle portion and the internal surface of the pressure transfer portion; the method comprising: inserting the hand of the practitioner into the opening; contacting the external surface of the compression device with the abdomen of the patient; and applying a compressive force to the pressure transfer portion by contacting a plurality of the proximal phalanges of the practitioner’s hand with the internal surface of the pressure transfer portion so as to exert a corresponding compressive force on the abdomen of the patient.

[0013] From a further aspect the invention provides a method for operating a compression device for compressing the descending abdominal aorta of a patient by a practitioner, wherein the compression device comprises: a pressure transfer portion comprising a substantially smooth external surface and an internal surface opposing the external surface, the pressure transfer portion having a thickness between 5mm and 20mm in a direction extending between the external surface and the internal surface, the internal surface being of an elastically compliant material; and a handle portion connected to the pressure transfer portion, defining an opening between the handle portion and the internal surface of the pressure transfer portion; the method comprising: inserting the hand of the practitioner into the opening; contacting the external surface of the compression device with the abdomen of the patient; and applying a compressive force to the pressure transfer portion by contacting a plurality of the proximal phalanges of the practitioner’s hand with the internal surface of the pressure transfer portion so as to exert a corresponding compressive force on the abdomen of the patient which is substantially evenly distributed across the external surface.

[0014] Thus, it will be seen that, in accordance with the invention, the force applied by the plurality of proximal phalanges of the practitioner to the internal surface of the pressure transfer portion is transferred to the external surface of the pressure transfer portion so as to apply an even pressure to the abdomen of the patient. The device thus provides an effective means of stopping or decreasing blood loss caused by haemorrhage of the descending abdominal aorta when performing a manual compression of this artery. In particular, the device provides even and consistent manual compression of the abdominal aorta compared to performing compression of the descending abdominal aorta using a bare fist, avoiding concentrations of pressure at the phalanges of the practitioner using the device. The compression device therefore provides effective temporary lifesaving treatment until further treatment can be provided.

[0015] The external surface of the pressure transfer portion is substantially smooth in accordance with the invention in order to ensure that the corresponding compressive force applied by the external surface is transmitted as an even pressure across the area in contact with the abdomen of the patient. Substantially smooth should be understood to mean without considerable undulation in the profile of the external surface, or in other words, without abrupt changes in the profile of the external surface. Whilst the external surface could be gently curved (e.g. with a radius of curvature of more than 50cm), in preferred embodiments the external surface is substantially flat.

[0016] The material which the pressure transfer portion is manufactured from may be advantageously chosen so as to facilitate the achievement of even pressure on the abdomen of the patient. Manufacturing the internal surface of the pressure transfer portion from an elastically compliant material advantageously allows the internal surface to deform around the proximal phalanges of the practitioner. This may allow a more even force to be transmitted from the practitioner to the abdomen of the patient. In some embodiments, the external surface of the pressure transfer portion is also manufactured from an elastically compliant material. This may avoid concentrations of pressure at the spinal column of the patient when the compression device is used to compress the aorta. In preferred embodiments, all of the pressure transfer portion is manufactured from the same elastically compliant material.

[0017] The Applicant has similarly appreciated that the thickness of the pressure transfer portion may be advantageously selected to ensure the substantially even distribution of pressure on the abdomen of the patient in accordance with the invention. If the thickness of the pressure transfer portion of the compression device were too thin, the uneven nature of the force profile applied by the proximal phalanges of the practitioner to the internal surface of the pressure transfer portion would be transferred from the internal surface of the pressure transfer portion to the external surface. This may apply an uneven pressure to the abdomen of the patient, and thus result in a less effective compression of the aorta. On the other hand, if the thickness of the pressure transfer portion were too thick, too great a proportion of the force applied by the practitioner may be absorbed by the pressure transfer portion rather than being transferred to abdomen of the patient. This may also lead to less effective compression of the aorta.

[0018] The optimum thickness will typically depend on the precise material used but in a set of embodiments, the thickness of the pressure transfer portion is between 5mm and 10mm.

[0019] In some embodiments the pressure transfer portion comprises an elastomer with a low Shore 00 hardness value. For example, an elastomer with a Shore 00 hardness value between 10 and 70, e.g. between 30 and 50 could be used. The tensile strength of the elastomer may be between 0.05-0.025MPa. The elongation at break of the elastomer may be greater than 1000%. The Applicant has found that manufacturing the pressure transfer portion from elastically compliant materials with these properties can allow the internal surface of the pressure transfer portion to deform sufficiently so as to distribute the uneven pressure applied by the phalanges of the practitioner, whilst the pressure transfer portion remains substantially rigid so as to transmit the compressive force applied by the practitioner to the surface of the abdomen of the patient. Furthermore, such materials can allow the practitioner to be sufficiently comfortable when applying the compressive force for them to be able to apply it for a sufficiently long period that other treatments can be given. The elastically compliant material of the pressure transfer portion could be an elastomer, e.g. a thermoplastic elastomer or, preferably, a silicone elastomer.

[0020] The handle portion makes it easier for the practitioner to apply an optimum force to the compression device during use. The handle portion can also allow the practitioner using the compression device to accurately position their proximal phalanges on the internal surface of the pressure transfer portion, so as to apply the compressive force to the internal surface of the pressure transfer portion in the correct direction.

[0021] The external surface of the pressure transfer portion would typically consist of a material which is classified as medically safe for contact with the body of a patient when said material is sterilised to advantageously allow direct contact of the compression device with the abdomen of the patient. Direct contact between the compression device and the abdomen of the patient is typically preferred as it may allow a more secure placement of the compression device. The material may be classified as medically safe for internal and external use. Internal compression of the aorta may be required through the open abdomen of a patient during a surgical procedure such as a caesarean-section.

[0022] Similarly, the internal surface of the pressure transfer portion preferably consists of a material which is classified as medically safe for contact with the body when sterilised.

[0023] The handle portion may be manufactured from a different material to the pressure transfer portion, but in a set of embodiments the handle portion and the pressure transfer portion are manufactured from the same material. In some embodiments the compression device may be manufactured as a single component- i.e. the pressure transfer portion and the handle portion may form a continuous component. This may simplify the manufacturing process for the compression device, consequently reducing associated costs. Manufacturing the compression device as a single component may also advantageously increase strength and reduce the number of points of potential failure in the compression device. This may be especially advantageous given that the compression device is designed to be subjected to and to transmit large forces in order to compress the descending abdominal aorta. For example, the compression device may be subject to between 100N and 600N of compressive force. The dimensions of the external surface of the pressure transfer portion are advantageously selected to correspond to the average size of the aorta. This may help to avoid compression of other blood vessels in comparison to methods of aortic compression which require compression of the whole abdomen of the patient (e.g. using a tourniquet belt).

[0024] In a set of embodiments, the pressure transfer portion has a length extending in a direction across the practitioner’s hand of between 85mm and 120mm, e.g. between 95mm and 110mm. The corresponding length of the internal surface of the pressure transfer portion should be sufficient to accommodate a normal range of the widths of the proximal phalanges of four fingers - in a set of embodiments this is between 55mm and 120mm, e.g. between 65mm and 80mm.

[0025] In a set of embodiments, the width of the pressure transfer portion (normal to the aforementioned length) is between 10mm and 100mm, e.g. between 25mm and 55mm. A width with these dimensions has been found to accommodate a substantial proportion of the typical length of the proximal phalanges of a practitioner on the internal surface of the pressure transfer portion when the practitioner applies a compressive force to the pressure transfer portion and to allow the corresponding compressive force to be applied of an area of the abdomen of patient which is sized appropriately for compression of the descending abdominal aorta. The Applicant has found that a width of at least 25mm is particularly effective for compressing the aorta when the compression device is positioned in the appropriate location relative to the aorta on the patient’s abdomen.

[0026] The handle portion of the compression device may be dimensioned such that it is suitable for being held between the palm and proximal phalanges of the practitioner using the device.

[0027] The handle portion may have a length extending in a direction parallel to the length of the pressure transfer portion between 70mm and 150mm, e.g. between 90mm and 100mm. A grip section of the handle may be dimensioned so as to be comfortably held by the hand of the practitioner when the practitioner’s hand is formed in a closed fist position around the grip. It may have a width of between 10mm to 40mm. The handle portion may be arranged relative to the pressure transfer portion such that the opening shaped to accommodate the hand of the practitioner is formed between the grip section of the handle portion and the internal surface of the pressure transfer portion. The opening may have a height of between 10mm and 35mm, e.g. between 10mm and 15mm.

[0028] Whilst the preferred dimensions are such as to accommodate a typical range of hand sizes, the Applicant has recognised that by manufacturing both the handle portion and the pressure transfer portion from an elastically compliant material the opening between the handle portion and the pressure transfer portion will be slightly flexible. As a result, the opening of the compression device may be able to accommodate a larger range of sizes of hands. Advantageously the opening will deform to fit the hand of the practitioner in such a way as to provide a secure fit over the four proximal phalanges of the practitioner, without the fit being uncomfortably tight. Having a tight fit may advantageously improve the ease and accuracy of use.

[0029] It should be appreciated that due to the elastic properties of the materials forming part or all of the compression device, the dimensions of the compression device may vary during use. In particular, the dimensions of the device when it is accommodating the hand of a practitioner during use may differ compared to when a practitioner’s hand is not accommodated. Equally, it is appreciated that the dimensions of the device may vary when the compressive force is applied by the practitioner. The dimensions described above refer to the dimensions of the compression device when the compression device is not being used, and the practitioner’s hand is not accommodated in the opening.

[0030] Features of any aspect or embodiment described herein may, wherever appropriate, be applied to any other aspect or embodiment described herein. Where reference is made to different embodiments or sets of embodiments, it should be understood that these are not necessarily distinct but may overlap.

[0031] BRIEF DESCRIPTION OF THE DRAWINGS

[0032] An embodiment of the invention will now be described, by way of example only, with reference to the accompanying drawings, in which: Figures 1 and 2 show application of a fist to a patient’s abdomen, respectively before and after aortic compression, without using the invention;

[0033] Figure 3A is a side view of a fist protector in accordance with the present invention;

[0034] Figure 3B is a second side view of the fist protector shown in Figure 3A;

[0035] Figure 3C is a top view of the fist protector shown in Figures 3A and 3B;

[0036] Figure 3D is an isometric view of the fist protector shown in Figures 3A, 3B and 3C;

[0037] Figure 4 shows a bottom view of the fist protector as held by a practitioner;

[0038] Figure 5 shows a side view of the first protector as held by a practitioner;

[0039] Figure 6 shows a second side view of the fist protector as held by a practitioner; and

[0040] Figure 7 shows the fist protector applied to a body in use to compress the aorta in the umbilical region of the body.

[0041] DETAILED DESCRIPTION

[0042] Figures 1 and 2 show how a practitioner may apply a manual external aortic compression using their fist, without using the invention.

[0043] In order to perform external aortic compression, the practitioner positions their fist 100 in a location on the abdomen of the body 120 above the aorta 160 in the umbilical region (Figure 1). The fist 100 is then used to apply a downwards compressive force on the body 120, which in turn compresses the aorta 160 against the spinal column 140 of the patient (Figure 2).

[0044] By applying compression to the aorta, bleeding is reduced from the uterus or birth canal by reducing its blood supply. Manual aortic compression with a closed fist just above the umbilicus can achieve near total arrest in femoral blood flow. This maneuver may temporarily reduce bleeding, allowing for fluid or blood resuscitation and if necessary, transfer to definitive treatment in the operating room. In 2015, the World Health organization (WHO) recommended manual aortic compression, to temporize bleeding in the case of post-partum hemorrhage (PPH), until appropriate care is available. Being able to apply effective compression to the aorta externally, in a non- invasive manner, may be particularly suitable in scenarios where the patient is not in a medical setting and / or the practitioner does not have access to the necessary equipment for surgical intervention.

[0045] During pregnancy the muscles of the abdominal wall stretch and separate leading to reduced resistance of the abdominal wall and the aortic compression can easily be performed if the patient suffers from PPH. This leads to a challenge in some women where the unevenness of the fist combined with the unevenness of the spinal column make it hard to compress aorta completely.

[0046] When a practitioner applies a downwards force to the skin of the patient using manual compression with a bare fist 100, the downwards force is concentrated over the area of the raised surface of the phalanges of the fist 100. This locally increases the pressure on the skin of the patient where the phalanges make contact with the skin of the patient’s body 120. In order to compress the aorta 160 against the spine 140 effectively, a more even application of force over a wider area of the abdomen of the patient is desirable. The device described herein seeks to address this problem.

[0047] Whilst the exemplary application described herein is for compression of the aorta following PPH, embodiments of the invention may be equally applicable to other scenarios where the aorta should be compressed. Embodiments of the invention may also be suitable for using in other medical procedures which require applying a compressive force to the body of a patient.

[0048] Figures 3A to 3D show a device 300 in accordance with the present invention, hereinafter referred to as a fist protector.

[0049] The fist protector 300 comprises a handle portion 320 and a pressure transfer portion 340. The pressure transfer portion 340 comprises an internal surface 342 and an external surface 344. A central opening 360 in the first protector is formed in between the handle portion 320 and the internal surface 342 of the pressure transfer portion 340. The handle portion 320 comprises a grip 322, a first side portion 324 and a second side portion 326. The grip 322 of the handle portion 320 extends between two ends of the handle portion 320 and is connected to the pressure transfer portion 340 at the first end of the handle portion 320 by the first side portion 324 and connected to the pressure transfer portion 340 at the second end of the handle portion 320 by the second side portion 326. Each respective side portion 324, 326 extends upward from the pressure transfer portion 340.

[0050] In the embodiment shown in Figures 3A, 3B, 3C and 3D, the handle portion 320 and the pressure transfer portion 340 form a single integrated component made of a silicone elastomer. However, it should be understood that in some embodiments the handle portion may be a separate component attached to the pressure transfer portion. The handle portion may therefore be manufactured from a different material to the pressure transfer portion.

[0051] The fist protector 300 is designed to be able to transfer at least 100N of compressive force in use.

[0052] In an example of the fist protector 300 shown in Figure 3A, 3B, 3C and 3D, the grip 322 of the handle portion 320 has a width of 12mm; the thickness of the pressure transfer portion 340 is 8mm; the width of the pressure transfer portion 340 is 45mm; the length of the pressure transfer portion is 95mm; the thickness of the pressure transfer portion 340 is 8mm; and the height of the opening 360 is 16mm.

[0053] The material and thickness of the pressure transfer portion 340 are designed so as to ensure that as much pressure as possible can be applied, evenly distributed across the external surface 344, when a practitioner applies a downwards force to the pressure transfer portion using their proximal phalanges.

[0054] If the pressure transfer portion of the compression device were too thin, the uneven nature of the force profile applied by the proximal phalanges of the practitioner to the internal surface of the pressure transfer portion may be transferred to the external surface of the pressure transfer portion. This may apply an uneven pressure to the abdomen of the patient, and thus result in a less effective compression of the aorta. On the contrary, if the pressure transfer portion were too thick, a greater proportion of the force applied by the practitioner would be absorbed by the pressure transfer portion rather than being transferred to the abdomen of the patient. This may also lead to less effective compression of the aorta. Equally, the material from which the pressure transfer portion is manufactured is important for the external surface 144 to be able to maximise and evenly exert pressure when a downwards force is applied to the internal surface 142. If the material from which the pressure transfer portion 340 is manufactured is too flexible, the uneven profile applied by the proximal phalanges of the practitioner may be partially or wholly transferred to the external surface 144. Further still, pressure may be concentrated at the uneven protrusions of the bones in the spinal column 140 of the patient when the compression device is used to compress the aorta 160. If the material from which the pressure transfer portion 340 is manufactured is too stiff, only the raised portions of the proximal phalanges would make contact with the internal surface 142 of the pressure transfer portion 340. As a result, the compression manoeuvre may be too uncomfortable for the practitioner to maintain for long enough to allow follow-on treatment to be administered. Equally, the aorta 160 may not be effectively compressed against the spinal column 140 due to the uneven protrusions of the bones in the spinal column 140.

[0055] It is envisaged that in some cases, the pressure transfer portion 340 of the fist protector 300 could be manufactured from more than one layer of material. For example, the internal surface 342 and the external surface 344 could each be manufactured by the same elastomer, or different respective elastomers. Any number of intermediate layers of material may be present between the internal surface 342 and the external surface 344. In order for the fist protector to be safe to use in a medical setting, it is envisaged that at least the exterior of the handle portion 320, the internal surface 342 and the external surface 344 are manufactured from a material which is classified as medically safe for contact with the body when sterilised.

[0056] As can be seen in Figures 3A and 3B, the internal surface 344 of the pressure transfer portion 340 is substantially smooth and flat, although a slight curvature could be provided - e.g. to accommodate unequal distribution of pressure across the practitioner’s fist.

[0057] Figure 4, Figure 5 and Figure 6 show how the fist protector 300 is designed to be gripped by the hand of a practitioner in use. As can be seen, the practitioner’s hand 400 is accommodated through the opening 360 between the handle portion 320 and the pressure transfer portion 340. The grip 322 of the handle portion 320 rests between the palm 420, the distal phalanges of the second, third, fourth and fifth fingers 440, 442, 444 and 446, and the proximal phalanges of the second, third, fourth and fifth fingers 460, 462, 464 and 466. The width of the grip 322 is dimensioned so as to be comfortably held by the hand of the practitioner when the practitioner’s hand is formed in a closed fist position around the grip 322 - e.g. as shown in Figure 3. The four proximal phalanges 460, 462, 464 and 466 fit across the length of the internal surface 342 of the pressure transfer portion 340 when positioned adjacent to one another. The width of the pressure transfer portion 340 covers a substantial proportion of the length of the proximal phalanges 460, 462, 464 and 466.

[0058] Figure 7 shows the fist protector 300 applied to a patient’s body 120 in use. As the practitioner grips the fist protector 300 and applies a downward compressive force, the proximal phalanges of the practitioner make contact with the internal surface 342 of the pressure transfer portion 340, and the external surface 344 of the pressure transfer portion 340 makes contact with the abdomen of the patient. The force exerted by pressure transfer portion 340 of the fist protector 300 compresses the aorta 160 against the spine 140 of the patient. The pressure transfer portion 340 enables the uneven pressure exerted by the proximal phalanges of the practitioner to be applied more evenly to the abdomen of the patient compared to compression using a bare fist. This consequently helps to protect the spinal column 140 when the aorta 160 is compressed.

[0059] As the dimensions of the external surface of the pressure transfer portion correspond to the average size of the aorta, compression of other blood vessels in the abdomen of the patient can advantageously be avoided. This can provide improvement in comparison to methods of aortic compression which require compression of the whole abdomen of the patient (e.g. using a tourniquet belt). PPH compression belt devices, such as the Abdominal Aortic Junctional Tourniquet™ (AAJT™) induce complete cessation of blood flow to the pelvis and lower extremities by overall abdominal compression. The Applicant has appreciated there are shortcomings associated with this method of abdominal compression, in particular that devices such as the AAJT™ also compress central veins in the abdomen. The post-partum uterus is enlarged and the upper boundary may be found above the umbilicus. The AAJT™ does not take this into consideration. As the AAJT™ generates the same pressure around the patient, the direct compression of the aorta against the spinal column is inhibited. The belt is therefore required to be tight to provide high pressure which leads to discomfort for the patient.

[0060] The fist protector 300 is also designed so as to be cost-effective to produce. Manufacturing the pressure transfer portion from one or more thermoplastic elastomers or a silicone elastomer allows the pressure transfer portion to be manufactured by injection moulding or 3D printing. The ability to use moulding or 3D printing as a method of manufacturing may advantageously reduce the cost of production of the compression device. At small production scales, the pressure transfer portion can also be manufactured by casting. The mould for casting can be manufactured by 3D printing, using Polylactic acid (PLA), for example.

[0061] Whilst the examples described in detail herein refer to external aortic compression, it should be appreciated that the invention could be used for internal direct compression of the aorta. This may be relevant in scenarios where a laparotomy has been performed on a patient, e.g. during a caesarean section operation or other surgical operation, and bleeding has occurred in the uterine, vaginal or femoral region.

[0062] It will be appreciated by those skilled in the art that the invention has been illustrated by describing one specific embodiment thereof, but is not limited to these embodiments; many variations and modifications are possible, within the scope of the claims.

Claims

CLAIMS1. A compression device for compressing the descending abdominal aorta of a patient, the device comprising: a pressure transfer portion comprising a substantially smooth external surface and an internal surface opposing the external surface, the pressure transfer portion having a thickness between 5mm and 20mm in a direction extending between the external surface and the internal surface, the internal surface being of an elastically compliant material; and a handle portion connected to the pressure transfer portion, defining an opening between the handle portion and the internal surface of the pressure transfer portion which is dimensioned to accommodate an adult hand of a practitioner; wherein the device is dimensioned such that in use, when the external surface is in contact with the abdomen of the patient and the practitioner applies a compressive force to the pressure transfer portion by contacting a plurality of the proximal phalanges of the practitioner’s hand with the internal surface of the pressure transfer portion, the external surface exerts a corresponding compressive force on the abdomen of the patient which is substantially evenly distributed across the external surface.

2. The compression device of claim 1 , wherein all of the pressure transfer portion is manufactured from the same elastically compliant material.

3. The compression device of claim 1 or 2, wherein the thickness of the pressure transfer portion is between 5mm and 10mm.

4. The compression device of any preceding claim, wherein the pressure transfer portion comprises an elastomer with a Shore 00 hardness value between 10 and 70.

5. The compression device of any preceding claim, wherein the tensile strength of the elastomer is between 0.05MPa and 0.025MPa.

6. The compression device of any preceding claim, wherein the elastically compliant material is a silicone elastomer.

7. The compression device of any preceding claim, wherein the handle portion and the pressure transfer portion are manufactured from the same material, and the compression device is manufactured as a single component.

8. The compression device of any preceding claim, wherein the pressure transfer portion has a length of between 85mm and 120mm.

9. The compression device of any preceding claim, wherein the width of the pressure transfer portion is at least 25mm.

10. The compression device of any preceding claim, wherein the handle portion is dimensioned such that it is suitable for being held between the palm and proximal phalanges of the practitioner using the device.

11. The compression device of any preceding claim, wherein the handle portion has a length between 70mm and 150mm.

12. A method for operating a compression device for compressing the descending abdominal aorta of a patient by a practitioner, wherein the compression device comprises: a pressure transfer portion comprising an external surface and an internal surface opposing the external surface; and a handle portion connected to the pressure transfer portion, defining an opening between the handle portion and the internal surface of the pressure transfer portion; the method comprising: inserting the hand of the practitioner into the opening; contacting the external surface of the compression device with the abdomen of the patient; and applying a compressive force to the pressure transfer portion by contacting a plurality of the proximal phalanges of the practitioner’s hand with the internal surface of the pressure transfer portion so as to exert a corresponding compressive force on the abdomen of the patient.

13. The method of claim 12, wherein:the external surface of the pressure transfer portion of the compression device is substantially smooth; the pressure transfer portion has a thickness between 5mm and 20mm in a direction extending between the external surface and the internal surface, the internal surface being of an elastically compliant material; and the compressive force exerted on the abdomen of the patient is substantially evenly distributed across the external surface of the pressure transfer portion.

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