Survey Of The Indications For Use Of Emergency Tourniquets

Kragh, John F; O'Neill, Michelle L; Beebe, Dorothy F; Fox, Charles J.; Beekley, Alec C.; Cain, Jeffrey S.; Parsons, Donald L; Mabry, Robert; Blackbourne, Lorne H.

doi:10.55460/36sq-1uqu

Cited by 28 publications

(8 citation statements)

References 34 publications

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“…Early tourniquet application to achieve hemorrhage control is well supported in the military literature with multiple studies demonstrating the prevention of shock and improvement in survival without increasing limb complication rates. [3][4][5][6]18,19 Tourniquet use for MET in the civilian population has seen a concomitant renewed interest. [20][21][22][23][24] Several early studies focused on the safety of civilian tourniquet use, finding that PH tourniquets used for civilian extremity trauma had a low complication rate and high potential for benefit.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…2,3 After United States military studies in 2003 demonstrated increased survival and few long-term complications with early tourniquet application in the field, military conflicts in Iraq and Afghanistan witnessed a resurgence in tourniquet use. [3][4][5][6] A renewed interest in civilian tourniquet use ensued despite a lack of evidence for their safety and efficacy in civilian populations. In 2013, the Hartford Consensus determined that public knowledge of basic hemorrhage control techniques, including tourniquet use, had the potential to save lives by preventing exsanguination.…”

mentioning

confidence: 99%

“…However, during the early part of the 20th century during World War I, concerns about the potential devastating consequences of limb ischemia and limb loss from prolonged tourniquet use led to widespread avoidance of tourniquet use, which persisted for nearly 100 years 2,3 . After United States military studies in 2003 demonstrated increased survival and few long-term complications with early tourniquet application in the field, military conflicts in Iraq and Afghanistan witnessed a resurgence in tourniquet use 3–6 …”

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confidence: 99%

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AAST multicenter prospective analysis of prehospital tourniquet use for extremity trauma

Schroll

Smith

Alabaster

et al. 2022

J Trauma Acute Care Surg

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BACKGROUND:Tourniquet use for extremity hemorrhage control has seen a recent increase in civilian usage. Previous retrospective studies demonstrated that tourniquets improve outcomes for major extremity trauma (MET). No prospective study has been conducted to date. The objective of this study was to evaluate outcomes in MET patients with prehospital tourniquet use. We hypothesized that prehospital tourniquet use in MET decreases the incidence of patients arriving to the trauma center in shock. METHODS:Data were collected prospectively for adult patients with MET at 26 Level I and 3 Level II trauma centers from 2015 to 2020. Limbs with tourniquets applied in the prehospital setting were included in the tourniquet group and limbs without prehospital tourniquets were enrolled in the control group. RESULTS:A total of 1,392 injured limbs were enrolled with 1,130 tourniquets, including 962 prehospital tourniquets. The control group consisted of 262 limbs without prehospital tourniquets and 88 with tourniquets placed upon hospital arrival. Prehospital improvised tourniquets were placed in 42 patients. Tourniquets effectively controlled bleeding in 87.7% of limbs. Tourniquet and control groups were similarly matched for demographics, Injury Severity Score, and prehospital vital signs ( p > 0.05). Despite higher limb injury severity, patients in the tourniquet group were less likely to arrive in shock compared with the control group (13.0% vs. 17.4%, p = 0.04). The incidence of limb complications was not significantly higher in the tourniquet group ( p > 0.05). CONCLUSION:This study is the first prospective analysis of prehospital tourniquet use for civilian extremity trauma. Prehospital tourniquet application was associated with decreased incidence of arrival in shock without increasing limb complications. We found widespread tourniquet use, high effectiveness, and a low number of improvised tourniquets. This study provides further evidence that tourniquets are being widely and safely adopted to improve outcomes in civilians with MET.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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AAST multicenter prospective analysis of prehospital tourniquet use for extremity trauma

Schroll

Smith

Alabaster

et al. 2022

J Trauma Acute Care Surg

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“…In order to reduce nerve damage, it is recommended that the width of the tourniquet cuff be increased, although the appropriate width of the tourniquet has not yet been firmly established (Beaven et al, 2017;Lewis, 2014). In addition, particular consideration must be held on the pressure exerted, as most complications are associated with this factor; insufficient pressure may lead to a paradoxical increase in bleeding (venous tourniquet) and excessive pressure may lead to nerve damage (Kragh et al, 2011(Kragh et al, , 2012.…”

Section: Discussionmentioning

confidence: 99%

Tourniquets as a haemorrhage control measure in military and civilian care settings: An integrative review

Román

Rodriguez-Alvarez

Bertini-Perez

et al. 2021

Journal of Clinical Nursing

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Aims and objectives: The aim of review was to describe and synthesise the evidence on the use of tourniquets to control haemorrhages, summarising both civilian and military use.Background: Trauma-related haemorrhage constitute one of the most preventable deaths among injured patients, particularly in multi-casualty incidents and disasters. In this context, safe instruments such as tourniquets are essential to help healthcare professionals to minimise loss of life and maximise patient recovery. Design and Methods: An integrative review was conducted in Medline, Nursing & Allied Health Premium, and Health & Medical Collection, using published data until March 2021 and following the PRISMA guidelines. Results: A total of 25 articles were included. Evidence has been synthesised to understand the use of different types of tourniquets, environment of application, indication for their placement and potential complications associated with tourniquet placement. Conclusions: Commercial tourniquets such as Combat Application Tourniquet orEmergency Tourniquet models are a valuable and safe instrument for haemorrhage control in both military and civilian out-of-hospital care settings. Nurses, as part of emergency teams, and other professionals should be aware that there is a possibility of adverse complications, but they are directly proportional to the time of tourniquet placement and generally temporary. In addition, national and international guidelines ensure the need for all civilian emergency services to be equipped with these devices, as well as for the training of healthcare professionals and first responders in their use.Relevance to clinical practice: Despite the lack of complications in the use of tourniquets in these cases, their use has been a matter of debate for decades. In this sense, this review 2 yields up-to-date guidelines in the use of tourniquets, their recommendations and their significance among professionals to manage complicated situations.

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The Careful Art of Resuscitation

Schwartz

Holcomb

2013

Common Problems in Acute Care Surgery

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Survey Of The Indications For Use Of Emergency Tourniquets

Cited by 28 publications

References 34 publications

AAST multicenter prospective analysis of prehospital tourniquet use for extremity trauma

AAST multicenter prospective analysis of prehospital tourniquet use for extremity trauma

Tourniquets as a haemorrhage control measure in military and civilian care settings: An integrative review

The Careful Art of Resuscitation

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