At this point, I think we've all heard about vacuum-induced uterine tamponade (where negative pressure is used to draw down the uterine walls and stop postpartum hemorrhage), which is achieved in our OBGYN colleagues world with the Jada device, something that costs between 600-1200 USD and that most emergency medicine doctors are not trained on. However, our colleagues in Columbia and South Africa have come up with an alternative: the simple gastric tube.
59 patients were enrolled in this randomized feasibility trial with the goal to look for a 50% reduction in the primary outcome (blood loss >1000ml) comparing a 24 Fr Levin gastric tube and standard balloon uterine tamponade. Patients were given a survey asking about their experiences with the two devices.
Researchers analyzed this both with intention-to-treat and with per-protocol analysis looking at their primary outcome, and while their intention-to-treat analysis fell sort of significance (p value = 0.07), their per protocol just snuck to significance (p value = 0.04). They had one patient who had to switch over from the suction tube/gastric tube over to a balloon tamponade method, which was responsible for the change in their intention-to-treat analysis falling short. Still, the fact that a gastric tube reduced postpartum hemorrhage >1000ml around 40% compared to standard balloon uterine tamponade is both impressive and intriguing to me. Additionally, patients reported that the suction tube was much less painful than the balloon tamponade.
Some caveats: a very small number of patients, lack of dedicated research staff/missing data, only in Columbia and South Africa
So if you're ever in a desperate situation with a hemorrhage postpartum patient without the appropriate resources, a gastric tube could be your best friend!
Singata-Madliki M, Nieto-Calvache AJ, Rivera Torres LF, et al. Suction tube uterine tamponade versus uterine balloon tamponade for treatment of refractory postpartum hemorrhage: A randomized clinical feasibility trial. Int J Gynaecol Obstet. 2025;170(1):326-337. doi:10.1002/ijgo.16164
