Fatal pulmonary embolism subsequent to the use of Esmarch bandage and tourniquet: A case report and review of literature

Abstract

We report a case of fatal pulmonary embolism (PE) following exsanguinations of lower limb in orthopedic surgery. A 30-year-old man was posted for fixation of a tibial plateau fracture on the seventh day after injury. Subarchnoid block was performed. Esmarch bandage was used for exsanguination of the limb and tourniquet was inflated. Within three minutes after tourniquet inflation, the patient became unconscious hypotensive, and collapsed. Resuscitation was instituted and spontaneous circulation restored. Right ventricular strain pattern on transthoracic echocardiography, increased levels of D-dimer, and Doppler examination of the lowerlimb confirmed deep venous thrombosis of right femoral vessels and PE. In spite of thrombolytic therapy with streptokinase and heparin, the patient died on the ninth day after the event. Cases of PE secondary to the use of Esmarch bandage and tourniquet are reviewed here to identify the risk groups and management of PE.

Nonfatal pulmonary embolism associated with the use of compression stockings in the lithotomy position after spinal anesthesia

“…In a literature review by Desai et al ., they found that there were 14 cases of PE related to the use of Esmarch bandage or tourniquet inflation [ 12 ]. They suggested that an increase in compartment pressure in the limb caused by these medical devices could dislodge thrombi in the lower limbs and lead to massive PE.…”

Comparison of lower limb lifting and squeeze exsanguination before tourniquet inflation during total knee arthroplasty

“…The Rhys-Davies exsanguinator has been reported to burst whilst being used for exsanguination [19]. And several studies reported fatal pulmonary embolism subsequent to the use of Esmarch badage and tourniquet [20–22].…”

Total Di̇z Replasmani Uygulanan Steri̇l Hazir Turni̇ke İle Pnömoti̇k Turni̇keni̇n Ameli̇yat Sonrasi Dönemde Deri̇n Ventrombozu Oluşumu Yönünden Karşilaştirilmasi

“…Turnikenin basınç uygulaması ve basıncının sona ermesinden hemen sonra meydana gelen pulmoner emboli atakları, basınç artması sırasında oluşan pulmoner embolide, turnike şişirildiğinde ekstremitede turnike bölme basıncının artmasıyla açıklanır ve bu trombozu çıkarmak için yeterli olabilir. Turnike basınç uygulaması sonlandıktan sonra pulmoner emboli oluştuğunda genel varsayım, bir venöz staz döneminin lokal tromboz ile ve bunu takiben embolizasyon ile sonuçlanmasıdır (13). Bu mekanizmalara ek olarak turnike; venöz staza, direkt travma yoluyla endotel hasarına ve kalsifiye kan damarlarının olası hasarlarına neden olmaktadır.…”