Potentially survivable fatal vascular access hemorrhage with tourniquet use: A post‐mortem analysis

Abstract

Background: The US military has prioritized battlefield hemorrhage control. Researchers credit tourniquet use, and a novel trauma care training program, with saving 1000-2000 lives in Iraq and Afghanistan. The Stop the Bleed campaign translates these lessons learned to the public. This is the first analysis of the potential impact of this newfound knowledge about tourniquet use for extremity fatal vascular access hemorrhage in a civilian population. Fatal vascular access hemorrhage includes bleeding from arteriovenous fistulas and grafts used for hemodialysis and central venous catheters. Methods: This is a retrospective study of decedent records. We selected Maryland death records from 2002-2017 using the following search terms: "graft," "shunt," "fistula," "dialysis," and "central venous catheter." The records were analyzed for potential survivability with a checklist of military criteria modified for a civilian population. Suicides were excluded. Two reviewers independently classified the deaths as either potentially survivable or non-survivable, and a third reviewer broke ties. Results: There were 111 deaths included in the final analysis. Ninety-two of the 111 decedents had potentially survivable extremity fatal vascular access hemorrhage. The remaining 19 records were excluded, because they did not have extremity hemorrhage. Zero decedents had hemorrhage deemed to be non-survivable with prompt tourniquet application. Conclusion: This study identified 92 Maryland extremity fatal vascular access hemorrhage decedents who potentially could have survived with tourniquet use-an average of 6 per year. These results suggest the need for further epidemiology investigation, as well as exploration of the risks and benefits of teaching and equipping vascular access patients and their caregivers to use tourniquets for life-threatening bleeding.

Systematic review of lay responders educational outcomes to identify life-threatening bleeding

“…Outcomes to Identify Life-Threatening Bleeding Jeffrey L. Pellegrino 1 , Stephen E. Smith 1 , Emma Banton 1 , Amita Sudhir 2 , 1 University of Akron, 2 University of Virginia Health System A severe hemorrhage in an out-of-hospital setting may lead to death faster than the expected time frame for medical professionals to arrive, let alone act (Goolsby et al, 2020;Lee et al, 2007;Passos et al, 2014). To counteract this, over one million laypersons and non-medical responders (e.g., police, school personnel) have now been trained to stop Life Threatening Bleeding (LTB) since the launch of the Stop the Bleed® (StB) campaign in the United States (American College of Surgeons, n.d.).…”

Implementation of a prehospital whole blood program: Lessons learned

“…Death from hemorrhagic shock may also occur from nontraumatic conditions, such as gastrointestinal bleeding, peripartum hemorrhage, hemodialysis graft rupture, and coagulopathic conditions 4,5 . Prehospital patients in hemorrhagic shock who receive blood products in the field from Emergency Medical Services (EMS) have been shown to have improved outcomes 6–9 .…”

The FAST VIP (First Aid for Severe Trauma “Virtual” in-Person) Educational Study

“…1 The 180 school shootings during the past decade, as well as recent evidence demonstrating the utility of early hemorrhage control in preventing deaths, has increased interest in training laypeople to treat injuries in school settings. [2][3][4][5][6] The challenge of educating the public to treat trauma increased since the coronavirus disease 2019 (COVID-19) pandemic began, especially since the normal classroom settings in which teachers and students learn were altered significantly.…”