Regional hypothermia protects against tourniquet neuropathy

Kelly, C. J.; Creagh, T.; Grace, Pierce A.; Bouchier‐Hayes, David

doi:10.1016/s0950-821x(05)80320-2

Cited by 19 publications

(5 citation statements)

References 24 publications

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“…Many methods have been described and continue to be developed that aim to reduce adverse events. These include the use of lower inflation pressures [47,60], entire limb cooling to extend ischemic time [34], alternately inflated two tourniquet cuffs to avoid prolonged compression under the cuff [50] and anesthetic techniques to improve cuff use and tolerance [2,4,30,77,78]. There nevertheless remains an absence of convincing scientific evidence to support any of these techniques.…”

Section: Discussionmentioning

confidence: 99%

Tourniquet Use in Upper Limb Surgery

Oragui

Parsons

White

et al. 2010

Hand (New York, N,Y.)

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Tourniquets are compressive devices that occlude venous and arterial blood flow to limbs and are commonly used in upper limb surgery. With the potential risk of complications, there is some debate as to whether tourniquets should continue to be routinely used. In this review, we first look at the different designs, principles, and practical considerations associated with the use of tourniquets in the upper limb. The modern pneumatic tourniquet has many design features that enhance its safety profile. Current literature suggests that the risk of tourniquet-related complications can be significantly reduced by selecting cuff inflation pressures based on the limb occlusion pressure, and by a better understanding of the actual level of pressure within the soft tissue, and the effects of cuff width and contour. The evidence behind tourniquet time, placement, and limb exsanguination is also discussed as well as special considerations in patients with diabetes mellitus, hypertension, vascular calcification, sickle cell disease and obesity. We also provide an evidence-based review of the variety of local and systemic complications that may arise from the use of upper limb tourniquets including pain, leakage, and nerve, muscle, and skin injuries. The evidence in the literature suggests that upper limb tourniquets are beneficial in promoting optimum surgical conditions and modern tourniquet use is associated with a low rate of adverse events. With the improvement in knowledge and technology, the incidence of adverse events should continue to decrease. We recommend the use of tourniquets in upper limb surgery where no contraindications exist.

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Section: Discussionmentioning

confidence: 99%

Tourniquet Use in Upper Limb Surgery

Oragui

Parsons

White

et al. 2010

Hand (New York, N,Y.)

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“…Three commercially available tourniquets that have been found to be reliable in combat and experimental situations are the Combat Application Tourniquet (CAT ® ), the Special Operations Forces Tactical Tourniquet (SOFTT ® ), and the Emergency and Military Tourniquet (EMT ® ). 150,161 One LOE 5 prospective but not randomized study 162 on prolonged tourniquet application during surgery and 2 LOE 5 animal studies 163,164 showed that local hypothermia of the extremity protected against adverse effects of ischemia.…”

Section: Consensus On Sciencementioning

confidence: 99%

Part 13: First Aid

Markenson¹,

Ferguson²,

Chameides³

et al. 2010

Circulation

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The International First Aid Science Advisory Board identified 38 questions in first aid practice that had not been subjected to an evidence review process or that needed to be updated since the 2005 process. Two or more members of the International First Aid Science Advisory Board volunteered to independently review the scientific literature and complete an evidence-based review worksheet summarizing the literature (see Part 2 of this supplement for additional information). After the evidence was presented to the full board, a draft consensus summary of the scientific evidence and a draft consensus treatment recommendation were developed and represented at a subsequent meeting. Thus, each question, evidence-based review, draft summary of science, and draft treatment recommendation was presented and discussed on 2 separate occasions, and a Consensus on Science and Treatment Recommendation was reached by the Board. This document is a report of the group's consensus.As in 2005, the worksheets revealed the continuing paucity of scientific evidence to support specific first aid interventions. Very little research is being conducted in first aid, and most of the recommendations are extrapolations from research and experience in other medical venues, animal studies, and case series. It is hoped that this document will be a stimulus to future research in first aid. First Aid for Medical Emergencies SummaryThe medical questions addressed include poisoning, anaphylaxis, oxygen administration, and aspirin administration for a suspected coronary event.No changes were recommended for first aid management of acute poisoning.In reviewing epinephrine administration for anaphylaxis, evidence was found that laypeople and some medical and prehospital professionals are unable to recognize the signs and symptoms of anaphylaxis and therefore cannot, without training, make an independent decision to administer epinephrine with an auto-injector or to administer a second dose if the first is not effective. This issue takes on added importance in view of legislation in some jurisdictions that permits these actions.No evidence was found, except in decompression injuries, to support the routine administration of oxygen by first aid providers.The administration of aspirin to a victim experiencing chest discomfort is problematic. The literature is clear on the benefit of early administration of aspirin in an acute coronary event, except when there is a clear contraindication, such as aspirin allergy or a bleeding disorder. Less clear, however, is whether first aid providers can recognize the signs and symptoms of an acute Consensus on ScienceThere are no human studies on the effect of treating oral caustic exposure with dilution therapy. One in vitro LOE 5 chemistry study 2 demonstrated no benefit from the addition of large volumes of diluent to either a strong base or a strong acid. Five LOE 5 animal studies 3-7 demonstrated histological benefit to the esophagus when a diluent was administered following exposure to an alkali or acid. Treat...

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“…22 In animal studies on rats reducing the limb temperature to 4˚C by application of cold gel packs was found to protect against tourniquet neuropathy after 3 h of tourniquet use. 23 In animal studies on pigs, in the group with skin temperatures reduced to a mean of 9.3˚C and muscle temperatures reduced to a mean of 16˚C, after 3 h tourniquet application, a reduction in muscle damage was found in the local hypothermia group. 24 Exposing the limb with a tourniquet to the environment to allow cooling or artificially trying to achieve local hypothermia may therefore be a consideration in situations with prolonged evacuation times to definitive care.…”

Section: Principles Of Tourniquet Applicationmentioning

confidence: 97%