A systematic review of the use of tourniquets and topical haemostatic agents in conflicts in Afghanistan and Iraq

Abstract

The recent conflicts in Afghanistan and Iraq have seen increased use of tourniquets and topical haemostatic agents in the management of battlefield trauma. The aim of this paper is to review the available evidence for their efficacy and continued use. A systematic review of the medical literature published as a consequence of conflicts in Iraq in Afghanistan was conducted to determine the clinical outcomes from the use of tourniquets and haemostatic agents for haemorrhage control in limb extremity injury. Studies were retrospective cohort or prospective observational studies by design. None were eligible for meta-analysis and control groups were rarely available for ethical reasons. Despite methodological limitations, tourniquets were shown to save lives if applied prior to the onset of shock or in a pre-hospital setting. Topical haemostatic agents were shown to be useful adjuncts in haemorrhage control with small numbers of complications. In the military setting, tourniquet use in extremity trauma improves survival when used prior to the onset of shock. Topical haemostatic agents provide additional means of haemorrhage control, though further studies to identify the most effective types are necessary. Adequate training and protocols for use must be implemented to prevent complications through use.