Efficacy of Novel Commercial Tourniquet Systems in Extremity Hemorrhage Control - An Ultrasound and Generated Force Study

Abstract

Introduction:Tourniquets (TQ) save lives. Although military-approved TQ are more effective than improvised TQ in controlling exsanguinating extremity hemorrhage, their bulk may preclude every day carry (EDC) by civilian lay-providers.Aim:The purpose of the current study was to compare the efficacy of 3 novel commercial TQ to a military-approved TQ.Methods:A convenience sample of EM residents was utilized. Four different TQ were evaluated: Gen 7 Combat Application Tourniquet (CAT; control), Stretch Wrap and Tuck Tourniquet (SWAT-T), Gen 2 Rapid Application Tourniquet System (RATS), and Tourni-Key (TK). Popliteal artery occlusion was determined using a ZONARE ZS3 ultrasound. Steady-state maximal generated force was measured for 30 seconds with a thin-film force sensor (Singletract). Opinions were solicited at the conclusion of the study.Results:Nine residents participated in the study (7 male, 2 female). Success rates for complete arterial occlusion were 89% CAT, 67% SWAT-T, 89% RATS, and 78% TK (H 0.89, p = 0.83). Mean (± SD) times to achieve occlusion were 10.4 ± 1.7 sec CAT, 23.1 ± 9.0 sec SWAT-T, 11.1 ± 3.8 sec RATS, and 20.0 ± 7.1 sec TK (F 9.71, p < 0.001). Steady-state maximal forces were 29.9 ± 1.2 N CAT, 23.4 ± 0.8 N SWAT-T, 33.0 ± 1.3 N RATS, and 41.9 ± 1.3 N TK. Participants felt that the CAT was easiest to apply (61%), followed by the RATS (33%). Participants were most likely to select the TK (44%) for EDC, followed by the RATS (33%).Discussion:In this small convenience sampling, all novel TQ systems were non-inferior to the military-approved CAT TQ. Mean application times were less than 30 seconds. The size and unique nature of these novel TQs may make them more conducive to lay-provider EDC, thereby improving the response to high threat events.