Use of tourniquets for hemorrhage control in civilian and military prehospital settings: metabolic, hemodynamic, and anatomical complications derived from exposure time
, 1, 1
Abstract
INTRODUCTION: Haemorrhage control is an essential component in the management of traumatized patients, given its significant global contribution of approximately 1.5 million annual deaths. Extremities, prone to bleeding, offer opportunities for early haemostatic intervention, recognizing tourniquets as critical lifesaving tools in severe limb injuries. Despite global acceptance in medical guidelines, concerns persist regarding ischaemic complications and limb loss associated with tourniquet application, especially in civilian settings. This scoping review aims to examine current literature on the use of tourniquets for haemorrhage control in both civilian and military settings. It seeks to assess metabolic, haemodynamic, and anatomical complications derived from tourniquet exposure duration.
MATERIAL AND METHODS: A search strategy was conducted following JBI and PRISMA-ScR protocols in PubMed databases. Study characteristics, setting, tourniquet time, environment, and reported complications were extracted from eligible studies.
RESULTS: The literature review identified 2094 studies, of which 9 met the inclusion criteria. These studies mainly originated from North America and Europe, with 8 being retrospective analyses. Characteristics of 2,136 participants who received tourniquet applications were evaluated, with 84.8% male representation. Complications were detailed in relation to exposure times, ranging from 22 to 268 minutes, revealing diverse outcomes, including temporary paraesthesia, acute kidney injury, nerve compression injuries, rhabdomyolysis, ischaemia/reperfusion injuries, and compartment syndrome.
CONCLUSIONS: This scoping review highlights the scarcity of local data and the need for a comprehensive assessment of tourniquet use in different traumatic scenarios. Understanding the specific impact of prolonged tourniquet application on clinical outcomes and complication rates is crucial for formulating guidelines and effective interventions in prehospital care.
Keywords: haemorrhageprehospital caretourniquetstraumacomplications
References
- Latif RK, Clifford SP, Baker JA, et al. Traumatic hemorrhage and chain of survival. Scand J Trauma Resusc Emerg Med. 2023; 31(1): 25.
- Kauvar DS, Lefering R, Wade CE. Impact of hemorrhage on trauma outcome: an overview of epidemiology, clinical presentations, and therapeutic considerations. J Trauma. 2006; 60(6 Suppl): S3–11.
- Martínez-Angarita J, Gelvez JA, Álvarez-Álvarez J. Tendencias en la mortalidad debida a lesiones causadas por trauma en Colombia, 2007-2017. Salud UIS. 2022; 54(1).
- Kragh JF, Dubick MA, Aden JK, et al. U.S. Military use of tourniquets from 2001 to 2010. Prehosp Emerg Care. 2015; 19(2): 184–190.
- Malo C, Bernardin B, Nemeth J, et al. Prolonged prehospital tourniquet placement associated with severe complications: a case report. CJEM. 2015; 17(4): 443–446.
- Scerbo MH, Mumm JP, Gates K, et al. Safety and appropriateness of tourniquets in 105 civilians. Prehosp Emerg Care. 2016; 20(6): 712–722.
- Ode G, Studnek J, Seymour R, et al. Emergency tourniquets for civilians: can military lessons in extremity hemorrhage be translated? J Trauma Acute Care Surg. 2015; 79(4): 586–591.
- Farhan-Alanie MM, Dhaif F, Trompeter A, et al. The risks associated with tourniquet use in lower limb trauma surgery: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol. 2021; 31(5): 967–979.
- Aromataris E, Munn Z. JBI Manual for Evidence Synthesis; JBI; 2020. https://synthesismanual.jbi.global (26.01.2024).
- Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (prisma-scr): checklist and explanation. Ann Intern Med. 2018; 169(7): 467–473.
- Ouzzani M, Hammady H, Fedorowicz Z, et al. Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016; 5(1): 210.
- Smith AA, Ochoa JE, Wong S, et al. Prehospital tourniquet use in penetrating extremity trauma: Decreased blood transfusions and limb complications. J Trauma Acute Care Surg. 2019; 86(1): 43–51.
- Bedri H, Ayoub H, Engelbart JM, et al. Tourniquet application for bleeding control in a rural trauma system: outcomes and implications for prehospital providers. Prehosp Emerg Care. 2022; 26(2): 246–254.
- Legare T, Schroll R, Hunt JP, et al. Prehospital tourniquets placed on limbs without major vascular injuries, has the pendulum swung too far? Am Surg. 2022; 88(9): 2103–2107.
- Schroll R, Smith A, Alabaster K, et al. AAST multicenter prospective analysis of prehospital tourniquet use for extremity trauma. J Trauma Acute Care Surg. 2022; 92(6): 997–1004.
- McCarthy EM, Burns K, Schuster KM, et al. Tourniquet use in the prehospital setting. Prehosp Emerg Care. 2024; 28(3): 531–535.
- Wellme E, Mill V, Montán C. Evaluating tourniquet use in Swedish prehospital care for civilian extremity trauma. Eur J Trauma Emerg Surg. 2021; 47(6): 1861–1866.
- McNickle AG, Fraser DR, Chestovich PJ, et al. Effect of prehospital tourniquets on resuscitation in extremity arterial trauma. Trauma Surg Acute Care Open. 2019; 4(1): e000267.
- Read DJ, Wong J, Liu R, et al. Prehospital tourniquet use in civilian extremity trauma: an Australian observational study. ANZ J Surg. 2023; 93(7–8): 1896–1900.
- Sabate-Ferris A, Pfister G, Boddaert G, et al. Prolonged tactical tourniquet application for extremity combat injuries during war against terrorism in the Sahelian strip. Eur J Trauma Emerg Surg. 2022; 48(5): 3847–3854.
- Gushing J, Blair SG, Albrecht RM, et al. Prehospital tourniquet placement in extremity trauma. Am J Surg. 2023; 226(6): 901–907.
- Joarder M, Noureddine El Moussaoui H, Das A, et al. Impact of time and distance on outcomes following tourniquet use in civilian and military settings: A scoping review. Injury. 2023; 54(5): 1236–1245.