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STEP 2Manual compression of the liver

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In case of active hemorrhage from the liver, the surgeon or ideally the assistant performs initial tamponade by manual compression for at least 10min. Then, two situations can be found:

1. When the hemorrhage can be controlled by manual compression, a competent team is available for appropriate assessment, and the patient is hemodynamically stable without hypothermia or acidosis, a one-step intervention leading to definitive surgical repair can be decided (see step 3).

2. When the hemorrhage is not controllable and hemodynamic instability, hypothermia, acidosis and coagulopathy occur, a liver packing (see step 9) with or without vascular control (see step 10) needs to be performed.