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Original article
Effect of prehospital tourniquets on resuscitation in extremity arterial trauma
  1. Allison G McNickle1,
  2. Douglas R Fraser1,
  3. Paul J Chestovich1,2,
  4. Deborah A Kuhls1,
  5. John J Fildes1
  1. 1 Department of Surgery, UNLV School of Medicine, Las Vegas, Nevada, USA
  2. 2 Surgery, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
  1. Correspondence to Dr Allison G McNickle, Department of Surgery, UNLV School of Medicine, Las Vegas, NV 89102, USA; allison.mcnickle{at}unlv.edu

Abstract

Background Timely tourniquet placement may limit ongoing hemorrhage and reduce the need for blood products. This study evaluates if prehospital tourniquet application altered the initial transfusion needs in arterial injuries when compared with a non-tourniquet control group.

Methods Extremity arterial injuries were queried from our level I trauma center registry from 2013 to 2017. The characteristics of the cohort with prehospital tourniquet placement (TQ+) were described in terms of tourniquet use, duration, and frequency over time. These cases were matched 1:1 by the artery injured, demographics, Injury Severity Score, and mechanism of injury to patients arriving without a tourniquet (TQ−). The primary outcome was transfusion within the first 24 hours, with secondary outcomes of morbidity (rhabdomyolysis, renal failure, compartment syndrome), amputation (initial vs. delayed), and length of stay. Statistical tests included t-test and χ2 for continuous and categorical variables, respectively, with p<0.05 considered as significant.

Results Extremity arterial injuries occurred in 192 patients, with 69 (36%) having prehospital tourniquet placement for an average of 78 minutes. Tourniquet use increased over time from 9% (2013) to 62% (2017). TQ+ patients were predominantly male (81%), with a mean age of 35.0 years. Forty-six (67%) received blood transfusion within the first 24 hours. In the matched comparison (n=69 pairs), TQ+ patients had higher initial heart rate (110 vs. 100, p=0.02), frequency of transfusion (67% vs. 48%, p<0.01), and initial amputations (23% vs. 6%, p<0.01). TQ+ patients had increased frequency of initial amputation regardless of upper (n=43 pairs) versus lower (n=26 pairs) extremity involvement; however, only upper extremity TQ+ patients had increased transfusion frequency and volume. No difference was observed in morbidity, length of stay, and mortality with tourniquet use.

Discussion Tourniquet use has increased over time in patients with extremity arterial injuries. Patients having prehospital tourniquets required a higher frequency of transfusion and initial amputation, without an increase in complications.

Level of evidence Therapeutic study, level IV.

  • extremity trauma
  • tourniquet
  • arterial injury
  • transfusion

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/tsaco-2018-000267

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    Footnotes

    • Presented at This work was presented as an e-poster at the 77th Annual Meeting of the American Association for the Surgery of Trauma, San Diego, California, September 2018.

    • Contributors AGM, DRF, and PJC designed the study. AGM performed the data collection. AGM, DRF, and PJC performed the data analysis. AGM, DRF, PJC, DAK, and JJF performed the data interpretation and contributed to article writing.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The University Medical Center of Southern Nevada Institutional Review Board approved this study.

    • Provenance and peer review Not commissioned; externally peer reviewed.