Abstract
Trauma is one of the leading causes of uncontrolled haemorrhage, death, and disability. Use of a tourniquet can be considered an optimal anti-haemorrhagic resource, in pre-hospital and emergency settings, and its lifesaving effect is clinically contradictory. This review aims to assess the clinical efficacy of the tourniquet in the emergency pre-hospital care setting for the management of haemorrhage. We conducted the systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, the PRISMA statement. We searched the following electronic databases: EMBASE, MEDLINE, and Cochrane-CENTRAL. All studies included were appraised for risk of bias. Prevalent primary outcomes were mortality and use of blood products. Secondary outcomes were related to adverse effects. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach (GRADE). Four studies were involved (1762 trauma patients). The adjusted odds ratio (aOR) of 0.47 (95% confidence Interval (CI) 0.19–1.16; three studies; 377 patients) for overall mortality estimates did not give a clear indication of the benefits of emergency pre-hospital tourniquets (PH-TQ) versus no pre-hospital tourniquet (NO PH-TQ) placement. The adjusted mean difference for blood product use was −3.28 (95% CI −11.22, 4.66) for packed red blood cells (pRBC) and −4.80 (95% CI −5.61, −3.99) for plasma, respectively. The certainty of evidence was downgraded to very low for all outcomes. Our results suggest an unclear effect of emergency pre-hospital tourniquet placement on overall mortality and blood product use. However, this systematic review highlights the availability of only observational studies and the absence of high quality RCTs assessing the efficacy of PH-TQs. Randomized controlled trials are needed.
Highlights
Every year, the lives of about 1.35 million people are cut short as a result of trauma caused by road traffic crashes, and between 20 and 50 million people worldwide suffer non-fatal injuries [1], with many incurring a disability [2]
The included studies allowed for the following comparisons: (1) pre-hospital tourniquet (PHTQ) versus tourniquet (NPH-TQ) [20,21,23]; and (2) pre-hospital tourniquet (TQ)
Our meta-analysis showed that use of pre-hospital tourniquets (PH-TQ) did not appear to significantly influence mortality
Summary
The lives of about 1.35 million people are cut short as a result of trauma caused by road traffic crashes, and between 20 and 50 million people worldwide suffer non-fatal injuries [1], with many incurring a disability [2]. Uncontrolled bleeding is the leading cause of death in 34% of trauma patients. Hospitalization with a mean stay of 7.3 days (standard deviation = ±14.6), a fatal outcome of 27.5%, and 17.4% of patients requiring transfusions in the emergency room [6]. Bleeding control in major trauma is a clinical priority that can be achieved through either direct compression or the use of mechanical or pneumatic tourniquets (TQ). The use and effectiveness of mechanical or pneumatic TQs appears to be associated with effective control of bleeding and lower mortality rates from bleeding [9].
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call