Evaluation of rapid training in ultrasound guided tourniquet application skills

Jaffer, Usman; Aslam, Mohammed; Kasivisvanathan, Veeru; Patni, Ravi; Midwinter, Mark J.; Standfield, N

doi:10.1016/j.ijsu.2012.08.019

Cited by 3 publications

(3 citation statements)

References 9 publications

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“…These pre-clinical failures are telling and suggest that there is likely a meaningful clinical consequence to not attending to discomfort. Indeed, in a study that compared guided versus unguided applications of windlass tourniquets the authors noted that applications guided by ultrasound had not only higher occlusion rates, but also significantly higher pain scores ( Jaffer et al, 2012). The relationship between pain and occlusion rates may negatively affect success if severe pain may become a barrier for patients and providers.…”

Section: Patient Tolerancementioning

confidence: 99%

Comparison Of Non-clinical Tourniquet Research for Appliance Superiority & Tolerance (CONTRAST)

Picard

O'Dochartaigh²,

Bakal³

et al. 2022

CJEN

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BACKGROUND: Tourniquets are effective tools to manage life-threatening extremity hemorrhage. Commercial devices are recommended over improvised ones; however, mass casualty incidents and austere environments may prevent access to commercial devices. The aim of this review is to systematically search and meta-analyze commercial and improvised tourniquets: arterial occlusion, application speed, and patient tolerance. METHODS: We searched MEDLINE, Embase, CINAHL, Cochrane Library, SPORTDiscus, and ProQuest Dissertations & Theses Global using controlled terms; without date limits. Manikin, animal, and operative studies were excluded. Tourniquet devices were pooled by design and compared. Data regarding provider training and experience, recipient anthropometrics, application site, ease of application, speed, tolerance, and device efficacy were examined. RESULTS: 5169 studies were screened. The 36 included studies were prospective trials on healthy volunteers and published between 2000 and 2021. There were 8205 unique tourniquet applications to 1921 subjects using 23 unique commercial and improvised devices. Median sample size of included studies was 20 (IQR 26) participants, ranging from 1 to 773 participants; and 102 (IQR=152) applications ranging from 20 individual applications to 1546 unique applications. The most commonly assessed outcomes were: effectiveness (n=30), pain (n=18), speed of application (n=13), and amount of mechanical advantage (ex. Windlass turns) required (n=13). Male participants outnumbered females 1,414 to 169, mean age ranged from 21 to 45 years of age. Devices were pooled into 5 categories according to mechanical advantage mechanism: elastic, friction, mechanical, pneumatic, and windlass. Initial hemostasis was achieved in 95% of upper extremity placements (CI=0.89-0.98, p= 0.02), and 88% of mid-thigh applications (CI=0.78-0.94, p>0.01), in both groups pneumatic and mechanical tourniquet devices had the highest rates of success, with friction and elastic devices having the lowest rates of success. Meta-analysis showed that mechanical and pneumatic advantage systems had superior rates of hemostasis, ease of use, and pain tolerance scores. Due to study heterogeneity, we could not determine which devices were the fastest to apply. The overall risk of bias assessment for included studies found the certainty of studies ranged from moderate to critical. CONCLUSION: In pre-clinical studies mechanical and pneumatic advantage systems appear to be the superior tourniquet design. Due to the low certainty of evidence and non-randomizable nature of traumatic injury, pre-clinical tourniquet devices will likely continue to be tested on well volunteers. Adoption of a minimum data set, agreed upon definitions for testable metrics, and a standardized experimental design could improve the comparability and quality of future tourniquet device studies.

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Section: Patient Tolerancementioning

confidence: 99%

Comparison Of Non-clinical Tourniquet Research for Appliance Superiority & Tolerance (CONTRAST)

Picard

O'Dochartaigh²,

Bakal³

et al. 2022

CJEN

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“…Numerous experimental studies have adopted this same assessment criterion. [21][22][23] However, in a real-life scenario, the only criterion for effectiveness is the stop of bleeding. Thus, it is difficult to compare Table 2.…”

Section: Effectivenessmentioning

confidence: 99%

“…Several other studies have evaluated the impact of training on tourniquet use. 10,11,22,26 The originality of this work was to conduct this evaluation in a combat zone, directly during the deployment in a military operation. This distinction is important.…”

Section: Assessment In a Combat Zonementioning

confidence: 99%

Tourniquet Training Program Assessed by a New Performance Score

Martinez

Duron²,

Schaal

et al. 2018

Prehosp. Disaster med.

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IntroductionApplication of a tourniquet is the cornerstone in management of combat-related extremity hemorrhages. Continuous and appropriate training is required to use tourniquets correctly.HypothesisThe aim of this study was to analyze the impact of a refresher training session, conducted directly in the theater of military operations, on the performance of tourniquet use.MethodsDuring their deployment (October 2015-April 2016) in the Central African Republic, a first simulation session evaluated soldiers from two combats platoons for the application of the SOFFT (Special Operation Forces Tactical Tourniquet; Tactical Medical Solutions; Anderson, South California USA) tourniquet. After randomization, a R (+) group underwent a refresher training session, while a R (−) group did not. Two months later, a second simulation session was conducted for both groups: R (+) and R (−). A dedicated score (one to seven points), including delay and effectiveness, evaluated the soldiers’ performance for tourniquet application.ResultsTwenty-six subjects were included in the R (+) group and 24 in the R (−) group. Between the two assessments, the score improved for 61.5% of subjects of the R (+) group and 37.5% subjects of the R (−) group (P=.09). More particularly, the performance score increased from 4.2 (SD=1.4) to 5.5 (SD=0.9; P=.002) in subjects of the R (+) group whose last training for tourniquet application was over six months prior.ConclusionA refresher tourniquet training session, conducted directly in a combat zone, is especially effective for soldiers whose last training session was over six months prior. A dedicated score can assess appropriately the performance of tourniquet training.MartinezT, DuronS, SchaalJV, BaudoinY, BarbierO, DabanJL, BoutonnetM, AussetS, PasquierP. Tourniquet training program assessed by a new performance score. Prehosp Disaster Med. 2018;33(5):519–525.

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