There are six important vital structures in the neck providing aerodigestive, nervous, endocrine, and circulatory functions and they are minimally protected by the skeletal system unlike other areas of the body. This lack of protection in the neck not only contributes to physician angst during treatment, but also to the high mortality and complication rate when injury occurs. Airway compromise and exsanguination are both very high priorities and the time required to deal with one can be to the detriment of the other. Rapidly controlling hemorrhage provides the time required to establish a definitive airway without further blood loss of an already depleted intravascular volume.
Delays in establishing definitive control of the airway can make the task of subsequent airway control difficult or impossible because of hematoma formation or injury/resuscitation induced edema leading to subsequent catastrophic airway obstruction. The Western Trauma Association (WTA) Critical Decisions in Trauma recommends direct manual pressure (DMP) be used as a first line response to penetrating neck injury. However, this approach has been associated with a low efficacy rate due to re-bleeding and exsanguination prior to reaching definitive operative care.