The safety and efficacy of improvised tourniquets in life-threatening hemorrhage: a systematic review

Cornelissen, Maarten Philip; Brandwijk, Anne; Schoonmade, Linda J.; Giannakópoulos, Georgios F.; Oostendorp, S. E. van; Geeraedts, L.M.G.

doi:10.1007/s00068-019-01202-5

Cited by 11 publications

(18 citation statements)

References 24 publications

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“…Requiring pre-hospital trauma life support certification at regular intervals should help with skill decline and continued education as this course is updated with the current evidence. Although in the majority of cases external haemorrhage will be controlled by employing a stepwise approach, TQ use could be considered as a potential anti-haemorrhagic resource, and its life-saving effect may become more apparent [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…Direct pressure should be maintained by health care personnel, which is sometimes insufficient in number. Use of a TQ can be considered an optimal anti-haemorrhagic resource in an emergency setting, and its lifesaving effect has become more apparent [ 8 ]. The use and effectiveness of mechanical or pneumatic TQs appears to be associated with effective control of bleeding and lower mortality rates from bleeding [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…This is why the Hartford Consensus Conference [ 10 ] encourages their widespread use among the civilian population for the early control of haemorrhage in the extremities (upper and lower limbs) when direct manual compression is ineffective or unfeasible. In the literature, the efficacy of TQ application for the management of bleeding in the pre-hospital phase in patients with major trauma is supported by relatively low, often contradictory evidence, or is even not recommended for use in the civilian context [ 8 ]. In particular, it remains an open question whether when used in the pre-hospital setting, it leads to better survival and a reduced need for blood, or blood component, transfusions.…”

Section: Introductionmentioning

confidence: 99%

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

Latina

Iacorossi

Fauci

et al. 2021

IJERPH

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Latina

Iacorossi

Fauci

et al. 2021

IJERPH

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“…The Stop the Bleed campaign has identified the importance of using commercial tourniquets over improvised tourniquets to stop extremity hemorrhage [7,9]. Improvised tourniquets have been shown to be inferior to commercial versions in their effectiveness in stopping life-threatening hemorrhage as belts, thin wire, or other objects may generate insufficient force and directly cause tissue trauma [17][18][19]. In this series, appliers of improvised tourniquets often used potentially injurious objects, such as surfboard leashes, boogie board leashes, dog leashes, rubber bands, and rope.…”

Section: Discussionmentioning

confidence: 99%

Tourniquet Use in Animal Attacks: An Analysis of News Media Reports

Wend

Goolsby

Schuler

et al. 2021

Cureus

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Background Animal attacks pose a significant public health problem in the United States. Non-venomous animals are the leading cause of mortality in these attacks, and extremity injuries leading to hemorrhage are a common pattern. The Stop the Bleed campaign advocates for public training in bleeding control tactics and public access to bleeding control kits. Controlling life-threatening bleeding, as promoted by the Stop the Bleed campaign, may be a method to reduce preventable death in these attacks. Methodology We searched the Nexus Uni database, which compiles international news media articles, to collect newspaper articles in the United States between 2010 and 2019 that referenced animal attacks on humans in which a tourniquet was applied. We screened articles to assess for inclusion criteria and isolated a single report for each attack. Results A total of 50 individual attacks met the inclusion criteria and were included for data collection. Overall, 92% (n = 46) of the victims survived the attacks, and the average victim age was 33. California was the most common location of the attacks (n = 12, 24%), sharks caused the most attacks (n = 26, 52%), and victims most often sustained isolated extremity injuries (n = 24, 48% for arm and n = 24, 48% for leg). Laypeople applied the most tourniquets (n = 29, 58%), and appliers most frequently used improvised tourniquets (n = 30, 60%). Conclusions While mortality in this series was low, there are hundreds of fatalities from non-venomous animal attacks each year. Equipping and training the at-risk public to stop bleeding may save additional lives. Future Stop the Bleed efforts should improve access to public hemorrhage control equipment and expand educational outreach to people engaged in high-risk activities with animals.

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“…[3][4][5][6][7] This is especially true of commercial tourniquets, which perform better at hemorrhage control than improvised tourniquets. [8][9][10][11][12][13] Nonetheless, rates of prehospital tourniquet application remain disappointing, as postmortem evaluation of civilian trauma deaths have shown that many are due to limb trauma and hemorrhage. [14][15][16] Preventable hemorrhage-related deaths in the context of mass-casualty shootings have led to the elaboration of the Hartford Consensus, [17][18][19] which recommends the empowerment of laypersons present at the site of mass-casualty events to act as immediate responders.…”

mentioning

confidence: 99%

Tourniquet application by schoolchildren—a randomized crossover study of three commercially available models

Bashtaly

Khalil

Méthot

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND: Life-threatening hemorrhage is a major cause of preventable mortality in trauma. Studies have demonstrated the effectiveness and safety of commercial tourniquets when used by adult civilians. However, there are no data about tourniquet application by children.This study's goal is to determine which of three commercially available tourniquets is most effective when used by children. METHODS:A randomized crossover study was conducted in four elementary schools in Montreal to compare three commercially available tourniquets.The study population is primary school children aged 10 to 12 years (5th-6th grade). A total of 181 students were invited to participate; 96 obtained parental approval and were recruited. Participants underwent a short 7-minute video training on the use of three commercial tourniquets and were subsequently given a 2-minute practice period. Students were evaluated on their ability to successfully apply the tourniquet and the time to complete application. After applying all three tourniquets, the students selected their favorite model. The primary outcome is the proportion of successful applications per tourniquet model. Secondary outcomes include time to successful application for each tourniquet model and tourniquet model preference. RESULTS:The mechanical advantage tourniquet (MAT) outperformed the combat application tourniquet (CAT) and the stretch wrap and tuck tourniquet (SWATT) in terms of success rate (MAT, 67%; CAT, 44%; SWATT, 24%; p < 0.0001), time to application (MAT, 57 seconds; CAT, 80 seconds; SWATT, 90 seconds; p < 0.0001), and preference (MAT, 64%; CAT, 30%; SWATT, 6%; p < 0.0001). CONCLUSION: In this study, the MAT performs better in terms of success rate, time to application, and preference when used by school-aged children. This study can be helpful when facilities are purchasing tourniquets for use by students.

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The safety and efficacy of improvised tourniquets in life-threatening hemorrhage: a systematic review

Cited by 11 publications

References 24 publications

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

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

Tourniquet Use in Animal Attacks: An Analysis of News Media Reports

Tourniquet application by schoolchildren—a randomized crossover study of three commercially available models

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