Effectiveness of Pre-Hospital Tourniquet in Emergency Patients with Major Trauma and Uncontrolled Haemorrhage: A Systematic Review and Meta-Analysis

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.

Association between Pre-Pregnancy Overweightness/Obesity and Pregnancy Outcomes in Women with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis

“…This meta-analysis was registered in PROSPERO (CRD42022300037) and was conducted adhering to the Meta-analyses of Observational Studies in Epidemiology (MOOSE) checklist and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [ 27 , 28 , 29 , 30 ]. Two reviewers (Drs.…”

Prehospital hemorrhage management in low‐ and middle‐income countries: A scoping review

“…Traumatic HM curricula focused on pressure/ elevation (88%, n = 15), tourniquet tying (88%, n = 15), and gauze application (82%, n = 14). Both pressure/ elevation and gauze application have consistently shown HM benefits, 36,37 but it is crucial to emphasize the use of clean gauze to reduce infection risk. In our review, Merchant et al 25 found that traditional Mozambican dresses, such as tree leaves and capulanas, were effective for low-resource HM; however, infection rates were not measured.…”

“…Other studies included case control or case reports (10%, n = 2), 25,33 randomized control trials (20%, n = 4), 20,26,27,32 and retrospective cohort studies (10%, n = 2). 22,28 Sixty percent (n = 16) of studies presented findings from Africa, [17][18][19][20][21][22][23][24][25][28][29][30][31][34][35][36] involving data from 12 countries. Three studies were conducted in Central or South America, 21,26,35 and three in South Asia or the Middle East.…”

Effect of comprehensive nursing intervention on the outcomes of in vitro fertilization in patients with polycystic ovary syndrome: A randomized controlled study

“…The fluctuation of their emotions can directly cause abnormal secretion of sex hormones, which is not conducive to egg cell quality. [23,24] A survey shows that patients undergoing IVF-ET have a very urgent need for health education. [25,26] Providing health information to such patients to meet their health education needs is a key task for assisted reproductive care personnel.…”