What is the evidence for using pressure points to control hemorrhage?

From the Guidelines

There is no evidence to support the use of pressure points to control hemorrhage, and direct manual pressure remains the mainstay of treatment for bleeding control. According to the 2024 American Heart Association and American Red Cross guidelines for first aid 1, direct manual pressure is the hallmark of hemorrhage control, and other methods such as tourniquet application or hemostatic dressings may be used as adjunctive measures. The guidelines explicitly state that there are no human studies assessing the effectiveness of manual pressure points in individuals with life-threatening bleeding.

Key Points for Hemorrhage Control

• Direct manual pressure is the primary method for controlling bleeding
• Tourniquets may be used for extremity bleeding that is not effectively controlled with direct pressure, but only when applied proximal to the wound
• Hemostatic dressings may be considered when standard bleeding control is not effective for severe or life-threatening bleeding
• Pressure points are not recommended for controlling external bleeding, as stated in the 2015 American Heart Association and American Red Cross guidelines update for first aid 1

Clinical Considerations

• Severe bleeding requires immediate medical attention, regardless of initial control methods
• Direct pressure on the wound should be maintained until medical help arrives
• Tourniquets and hemostatic dressings should only be used by trained individuals, as improper application can cause harm. The 2015 guidelines update 1 emphasizes the importance of proper training for first aid providers in the application of these devices.

Recommendations

• Direct manual pressure should be the first-line approach for controlling bleeding, with other methods used as adjunctive measures when necessary
• First aid providers should be trained in the proper application of tourniquets and hemostatic dressings, as well as the use of direct manual pressure for bleeding control 1

From the Research

Evidence for Using Pressure Points to Control Hemorrhage

• The use of pressure points to control hemorrhage is mentioned in a systematic review of the effectiveness of treatment modalities for severe, life-threatening external bleeding in the out-of-hospital first aid setting 2.
• This review included 107 studies with 22,798 patients and found that pressure points were one of the methods used for bleeding control, although the certainty of evidence was very low.
• Another study discussed the use of elastic adhesive dressing for bleeding control, which involves applying an adhesive elastic bandage directly over a collection of gauze pads placed on the wound surface to achieve hemorrhage control 3.
• However, this study did not specifically mention the use of pressure points.
• A review of hemorrhage control methods in small animals mentioned that direct pressure, wound packing, hemostatic dressings, pressure bandage, and tourniquet application are common interventions for controlling acute life-threatening hemorrhage, but did not discuss the use of pressure points 4.
• Other studies discussed the use of hemostatic dressings, tourniquets, and novel devices for controlling extremity hemorrhage, but did not mention the use of pressure points 5, 6.

Limitations of Current Evidence

• The current evidence on the use of pressure points to control hemorrhage is limited, with only a few studies mentioning this method.
• The certainty of evidence for pressure points is very low, making it difficult to draw robust conclusions about their effectiveness.
• More research is needed to fully understand the role of pressure points in controlling hemorrhage and to determine their effectiveness compared to other methods.