Safe Tourniquet Use: A Review of the Evidence

Fitzgibbons, Peter G.; DiGiovanni, Christopher W.; Hares, Sayed; Akelman, Edward

doi:10.5435/jaaos-20-05-310

Cited by 77 publications

(93 citation statements)

References 58 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Assuming that tourniquet and transport times are nearly equivalent, our recorded transport times took 31 (23, 39) minutes, which is considerably shorter than the 2 hours used for tourniquets in the operating room. 45, 46 However, it is difficult to conclude that the limited observation of complications would be observed regardless of tourniquet time or in a setting with an immature trauma system with prolonged transport times. The retrospective nature of this study additionally limited the abstraction of specific information regarding location of the five nerve palsies in relation to the level of the tourniquet.…”

Section: Discussionmentioning

confidence: 99%

Safety and Appropriateness of Tourniquets in 105 Civilians

Scerbo¹,

Mumm²,

Gates³

et al. 2016

Prehospital Emergency Care

View full text Add to dashboard Cite

Background The United States military considers tourniquets to be effective for controlling bleeding from major limb trauma. The purpose of this study was to assess whether tourniquets are safely applied to the appropriate civilian patient with major limb trauma of any etiology. Methods Following IRB approval, patients arriving to a level-1 trauma center between October 2008 and May 2013 with a prehospital (PH) or emergency department (ED) tourniquet were reviewed. Cases were assigned the following designations: absolute indication (operation within 2 hours for limb injury, vascular injury requiring repair/ligation, or traumatic amputation); relative indication (major musculoskeletal/soft-tissue injury requiring operation 2–8 hours after arrival, documented large blood loss); and non-indicated. Patients with absolute or relative indications for tourniquet placement were defined as indicated, while the remaining were designated as non-indicated. Complications potentially associated with tourniquets, including amputation, acute renal failure, compartment syndrome, nerve palsies, and venous thromboembolic events, were adjudicated by orthopedic, hand or trauma surgical staff. Univariate analysis was performed to compare patients with indicated versus non-indicated tourniquet placement. Results A total of 105 patients received a tourniquet for injuries sustained via sharp objects, i.e., glass or knives (32%), motor vehicle collisions (30%), or other mechanisms (38%). A total of 94 patients (90%) had indicated tourniquet placement; 41 (44%) of which had a vascular injury. Demographics, mechanism, transport, and vitals were similar between patients that had indicated or non-indicated tourniquet placement. 48% of the indicated tourniquets placed PH were removed in the ED, compared to 100% of the non-indicated tourniquets (p < 0.01). The amputation rate was 32% among patients with indicated tourniquet placement (vs. 0%; p = 0.03). Acute renal failure (3.2 vs. 0%, p = 0.72), compartment syndrome (2.1 vs. 0%, p = 0.80), nerve palsies (5.3 vs. 0%; p = 0.57), and venous thromboembolic events (9.1 vs. 8.5%; p = 0.65) and were similar in patients that had indicated compared to non-indicated tourniquet placement. After adjudication, no complication was a result of tourniquet use. Conclusion The current study suggests that PH and ED tourniquets are used safely and appropriately in civilians with major limb trauma that occur via blunt and penetrating mechanisms.

show abstract

Section: Discussionmentioning

confidence: 99%

Safety and Appropriateness of Tourniquets in 105 Civilians

Scerbo¹,

Mumm²,

Gates³

et al. 2016

Prehospital Emergency Care

View full text Add to dashboard Cite

show abstract

“…This “2-hour window” was derived from a considerable body of evidence from animals and clinical studies, which clearly show that tourniquet use produces morphological, electrophysiological, and functional impairments that are significant and increase in severity as tourniquet duration increases, but appear, in general, to be reversible with time (12). A review from 2012 entitled “Safe Tourniquet Use: A Review of the Evidence” included eight “high-quality clinical studies” to support the recommendation that, “while early electrophysiological changes and muscle atrophy are detectable, long-term functional differences are rare, and outcomes between standard tourniquet and no-tourniquet groups are equivocal’ (see Fitzgibbons et al , 2012 and references therein).…”

Section: Introductionmentioning

confidence: 99%

“…Included are brief reviews of the mechanisms governing muscle protein synthesis and degradation as well as cell and endoplasmic reticulum (ER) stress responses. To supplement this brief review, readers are encouraged to take advantage of the many excellent published reviews which cover relevant areas: immune and complement activation of IR injury (3), signaling pathways controlling translation (36), mitochondrial reactive oxygen species generation (31), ER stress and mitochondrial involvement in cell survival (26), ER stress in skeletal muscle (7), clinical perspective on safe tourniquet use (12), and cell biology of IR injury (18). …”

Section: Introductionmentioning

confidence: 99%

Tourniquet Use During Knee Replacement Surgery May Contribute to Muscle Atrophy in Older Adults

Dreyer

2016

Exercise and Sport Sciences Reviews

View full text Add to dashboard Cite

Muscle atrophy after total knee arthroplasty (TKA) occurs at a rate of 1% per day for the first two weeks. Our hypothesis is that tourniquet-induced IR injury occurring during TKA influences metabolism and may contribute to atrophy. Identifying pathways that are up regulated during this critical “14-day window” after surgery may help us to delineate therapeutic approaches to avoid muscle loss.

show abstract

“…It has been recommended that TT be limited to 2 h in human studies due to the increase in postoperative complications caused by an extended TT [10]. Investigating the relationship between TT and postoperative complications in arthroplastic knee surgery, Olivecrona et al [17] found an increase in postoperative complications including wound leakage, local injury due to TP, nerve damage, compartment syndrome, deep venous thrombosis, and pulmonary embolism with every 10-min increment in TT.…”

Section: Discussionmentioning

confidence: 99%

“…Studies on healthy volunteers have suggested that the TT should be limited to 2 h [1, 4, 10]. The risk of systemic complications increases with time, especially in patients with morbid obesity, a history of peripheral vascular surgery, and severe left-ventricular dysfunction, as well as in elderly and trauma patients [1].…”

Section: Introductionmentioning

confidence: 99%

Does Tourniquet Time or Pressure Contribute to Intracranial Pressure Increase following Tourniquet Application?

Beşir

Tuğcugil

2018

Med Princ Pract

View full text Add to dashboard Cite

Objective: The aim of this study was to determine whether an early increase in intracranial pressure (ICP) following the deflation of a tourniquet is related to the tourniquet time (TT) or tourniquet pressure (TP) and to identify a safe cut-off value for TT or TP. Materials and Methods: Patients who underwent elective orthopedic lower-extremity surgery under general anesthesia were randomized into 2 groups: group A (inflation with a pneumatic TP of systolic blood pressure + 100 mm Hg; n = 30) and group B (inflation using the arterial occlusion pressure formula; n = 30). The initial and maximum TPs, TT, and sonographic measurements of optic-nerve sheath diameter (ONSD) and end-tidal CO₂ values were taken at specific time points (15 min before the induction of anesthesia, just before, and 5, 10, and 15 min after the tourniquet was deflated). Results: The initial and maximum TPs were found to be significantly higher in group A than in group B. At 5 min after the tourniquet deflation, there was a significant positive correlation between TT and ONSD (r = 0.57, p = 0.0001). When ONSD ≥5 mm was taken as a standard criterion, the safe cut-off value for the optimal TT was found to be < 67.5 min (sensitivity 87% and specificity 59.5%). Conclusion: The ICP increase in the early period after tourniquet deflation was well correlated with TT but not with TP. TT of ≥67.5 min was found to be the cut-off value and is considered the starting point of the increase in ICP after tourniquet deflation.

show abstract

Safe Tourniquet Use: A Review of the Evidence

Cited by 77 publications

References 58 publications

Safety and Appropriateness of Tourniquets in 105 Civilians

Safety and Appropriateness of Tourniquets in 105 Civilians

Tourniquet Use During Knee Replacement Surgery May Contribute to Muscle Atrophy in Older Adults

Does Tourniquet Time or Pressure Contribute to Intracranial Pressure Increase following Tourniquet Application?

Contact Info

Product

Resources

About