References
Tourniquets in the treatment of prehospital haemorrhage
Abstract
Background:
During recent conflicts in Iraq and Afghanistan, tourniquets were a useful tool in the management of non-compressible prehospital catastrophic haemorrhage. Recommendations for use within the civilian setting were then made. However, civilian research supporting this change in practice is limited.
Aims:
The aim of the research is to evaluate the utility of prehospital tourniquet application through description of the complications associated with use, as well as identification of mortality following prehospital application.
Methods:
A literature search was completed using PubMed and Embase for research studies on prehospital tourniquet use in extremity trauma. Study relevance was confirmed via their abstracts and final selection was made through reviewing the full publication. Data were extracted on mortality, complications, indication for use, effective application and application duration of tourniquet use. This was tabulated, and a descriptive analysis performed.
Results:
The research reported a mortality range of 3–14% with an associated complication rate of 2.1–32.4%. The effectiveness of prehospital application was in the 88.8–98.7% range, with tourniquet application durations of 48–103.2 minutes.
Conclusions:
The tourniquet should continue to be available to UK paramedics for the management of prehospital non-compressible catastrophic haemorrhage. Application is likely to provide a mortality benefit with limited morbidity and associated complications.
Tourniquets are one of the earliest medical devices to stop active haemorrhage, dating back approximately three millennia (Richey, 2007; Taylor et al, 2011). The device rapidly stops arterial and venous blood flow distally to the application site. Historically, tourniquets were primarily used by military personnel, who shaped their initial development (Mabry, 2006). Despite this, in 1962, Klenerman (1962) supported their discontinuation because studies suggested ‘ineffectiveness’ or ‘harmful’ side effects. This subsequently became a part of international guidelines on haemorrhage control (Giannou and Baldman, 2009). This shift in opinion was in part because research and data confirming a benefit to mortality were limited, and anecdotal evidence suggested possible ischaemic and neurovascular complications.
Two pieces of epidemiological research led by Bellamy (Bellamy, 1984; Bellamy et al, 1986) sparked the reissuing of tourniquets for military use. The studies evaluated data from the Vietnam war to ascertain causes of death. The data showed that many deaths were from exsanguination. As a result, Butler et al (1996) promoted rapid application of tourniquets during combat.
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