Tourniquet use for civilian extremity hemorrhage: systematic review of the literature.

Carlos Yánez Benítez,Bruno M Pereira,Daniel Souza Lima,Pablo Ottolino,Mansoor Khan,Marcelo Augusto Fontenelle Ribeiro Junior,Antonio Guemes

doi:10.1590/0100-6991e-20202783

Abstract

extremity tourniquet (TQ) use has increased in the civilian setting; the beneficial results observed in the military has influenced acceptance by EMS and bystanders. This review aimed to analyze extremity TQ types used in the civilian setting, injury site, indications, and complications. a systematic review was conducted based on original articles published in PubMed, Embase, and Cochrane following PRISMA guidelines from 2010 to 2019. Data extraction focused on extremity TQ use for hemorrhage control in the civilian setting, demographic data, study type and duration, mechanism of injury, indications for use, injury site, TQ type, TQ time, and complications. of the 1384 articles identified, 14 were selected for review with a total of 3912 civilian victims with extremity hemorrhage and 3522 extremity TQ placements analyzed. The majority of TQs were applied to male (79%) patients, with blunt or penetrating trauma. Among the indications for TQ use were hemorrhagic shock, suspicion of vascular injuries, continued bleeding, and partial or complete traumatic amputations. Upper extremity application was the most common TQ application site (56%), nearly all applied to a single extremity (99%), and only 0,6% required both upper and lower extremity applications. 80% of the applied TQs were commercial devices, and 20% improvised. TQ use in the civilian setting is associated with trauma-related injuries. Most are single-site TQs applied for the most part to male adults with upper extremity injury. Commercial TQs are more commonly employed, time in an urban setting is under 1 hour, with few complications described.

Highlights

There are still controversies and preconceived myths surround the use of TQs for extremity hemorrhage and its evolution from the military to the civilian setting1
Recent publications from the military have proven that TQ use is effective for extremity hemorrhage, achieving a reduction in mortality when applied at the point of injury1,7
Most of the studies collected data over five years13-21, thirteen reports were from the United States and one from Canada15

Summary

Introduction

There are still controversies and preconceived myths surround the use of TQs for extremity hemorrhage and its evolution from the military to the civilian setting. Recent publications from the military have proven that TQ use is effective for extremity hemorrhage, achieving a reduction in mortality when applied at the point of injury. Recent publications from the military have proven that TQ use is effective for extremity hemorrhage, achieving a reduction in mortality when applied at the point of injury1,7 These findings, along with the increasing threat to civilians from random shootings and terrorist attacks in North America and Europe has generated a growing interest for TQs by the public, law enforcement agencies, and EMS. With the increase in TQ use by civilians, there is an increase in concerns regarding TQ safety and complications. Most of the reported experience in the civilian setting is focused in large urban areas in the U.S; indications for their use and risk of complications are not clearly defined. This systematic review aims to analyze demographics and experience of TQ use for extremity hemorrhage in the civilian setting,

Objectives

Results

Conclusion