Non-pneumatic anti-shock garment (NASG) applied at the primary health clinic is associated with faster recovery from hypovolemic shock secondary to obstetric hemorrhage

The Non-pneumatic Anti-Shock Garment (NASG), a first-aid device for obstetric hemorrhage (OH), has been shown to reduce blood loss and time to recovery from shock when applied at the referral hospital (RH) level. It is unknown whether women have better outcomes if they receive the NASG earlier in their course of care. In this analysis we evaluate recovery from shock among women who received the NASG at the primary health clinic (PHC) versus the RH. We compared the recovery trajectories of 684 women with hypovolemic shock enrolled within a larger randomized clinical trial of the NASG in Zambia and Zimbabwe. Women entered the study at the PHC and either received the NASG immediately and then were transferred (n=326, 47.6%) or were transferred to the RH prior to NASG receipt (n=358, 56.3%). Recovery was defined as return to normal shock index (<0.90). Kaplan-Meier survival analysis was used for simple between-groups comparisons while Cox Regression shared frailty models were estimated to evaluate adjusted group differences. Median recovery times were 170 minutes for the NASG at PHC group versus 209 minutes for NASG at RH (p=0.03). The adjusted rate of recovery was 25% higher in the NASG at PHC group compared to the NASG at RH (HR 1.25, 95% CI 1.02 – 1.52). Each 10 minute delay in NASG application was associated with a significantly lower recovery rate. Among women with OH, early application of the NASG is associated with faster recovery, which supports situating the NASG at the primary care level.