Safety and Appropriateness of Tourniquets in 105 Civilians

Abstract

Background The United States military considers tourniquets to be effective for controlling bleeding from major limb trauma. The purpose of this study was to assess whether tourniquets are safely applied to the appropriate civilian patient with major limb trauma of any etiology. Methods Following IRB approval, patients arriving to a level-1 trauma center between October 2008 and May 2013 with a prehospital (PH) or emergency department (ED) tourniquet were reviewed. Cases were assigned the following designations: absolute indication (operation within 2 hours for limb injury, vascular injury requiring repair/ligation, or traumatic amputation); relative indication (major musculoskeletal/soft-tissue injury requiring operation 2–8 hours after arrival, documented large blood loss); and non-indicated. Patients with absolute or relative indications for tourniquet placement were defined as indicated, while the remaining were designated as non-indicated. Complications potentially associated with tourniquets, including amputation, acute renal failure, compartment syndrome, nerve palsies, and venous thromboembolic events, were adjudicated by orthopedic, hand or trauma surgical staff. Univariate analysis was performed to compare patients with indicated versus non-indicated tourniquet placement. Results A total of 105 patients received a tourniquet for injuries sustained via sharp objects, i.e., glass or knives (32%), motor vehicle collisions (30%), or other mechanisms (38%). A total of 94 patients (90%) had indicated tourniquet placement; 41 (44%) of which had a vascular injury. Demographics, mechanism, transport, and vitals were similar between patients that had indicated or non-indicated tourniquet placement. 48% of the indicated tourniquets placed PH were removed in the ED, compared to 100% of the non-indicated tourniquets (p < 0.01). The amputation rate was 32% among patients with indicated tourniquet placement (vs. 0%; p = 0.03). Acute renal failure (3.2 vs. 0%, p = 0.72), compartment syndrome (2.1 vs. 0%, p = 0.80), nerve palsies (5.3 vs. 0%; p = 0.57), and venous thromboembolic events (9.1 vs. 8.5%; p = 0.65) and were similar in patients that had indicated compared to non-indicated tourniquet placement. After adjudication, no complication was a result of tourniquet use. Conclusion The current study suggests that PH and ED tourniquets are used safely and appropriately in civilians with major limb trauma that occur via blunt and penetrating mechanisms.

A Preliminary Comparison of Three Tourniquet Instructions for Just-in-Time Guidance of a Simulated Tourniquet Application

“…Military experience demonstrates that tourniquet use saves lives; even after many hours of tourniquet use, tissues that were deprived of blood can still heal without the need for amputation (Beekley et al, 2008;Kragh Jr, Baer, & Walters, 2007;Kragh Jr et al, 2009;Lakstein et al, 2003). Although the civilian literature is sparse, similar results have been noted (Scerbo et al, 2016;Stiles, Cook, & Sztajnkrycer, 2017).…”

Overall Anatomic Severity and Prognosis in Patients Presenting with, or Requiring a Major Lower Limb Amputation from Civilian Trauma

“…There is a significant difference in kinetic energy between improvised explosive devices (IEDs) blasts and road traffic collisions (RTC); therefore, the severity and characteristics of these injuries are different. In contrast with previous studies [5,[11][12][13], our results show that the most common mechanism of LLA in the civilian population was subway train run-over with 9 (26.4%) patients, and pedestrian run-over, with 8 (23.6%) patients. These results are consistent with the data from the National Trauma Databank [12].…”

Morphological Regeneration and Functional Recovery of Neuromuscular Junctions after Tourniquet-Induced Injuries in Mouse Hindlimb

“…The tourniquet is commonly used for severe limb hemorrhage and is often necessary to save life (Beekley et al, 2008; Inaba et al, 2015; Zietlow et al, 2015; Scerbo et al, 2016). However, a number of complications, including serious injuries to the skeletal muscle, nerve, and NMJ, are related to both tourniquet treatment and subsequent tourniquet release (Ochoa et al, 1971; Kam et al, 2001; Doyle and Taillac, 2008).…”