Tourniquet use for peripheral vascular injuries in the civilian setting

Passos, Edward; Dingley, Brittany; Smith, Andrew; Engels, Paul T.; Ball, Chad G.; Faidi, Samir; Nathens, Avery B.; Tien, Homer

doi:10.1016/j.injury.2013.11.031

Cited by 92 publications

(79 citation statements)

References 32 publications

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“…In 2014, Canadian investigators from 2 civilian trauma centers reported on tourniquet use for peripheral arterial injuries in isolated extremity trauma; of 190 cases included, 4 had out-of-hospital tourniquets and another 4 had trauma bay tourniquets. 8 None of the 8 patients with tourniquets died, whereas 6 of the 182 patients without tourniquets died; patients with tourniquets tended to have worse shock, but the difference was not statistically significant, perhaps because there were so few cases. 7 Several findings contribute to a bias against finding a survival benefit in the present study.…”

Section: Discussionmentioning

confidence: 93%

Transfusion for Shock in US Military War Casualties With and Without Tourniquet Use

Kragh¹,

Nam²,

Berry³

et al. 2015

Annals of Emergency Medicine

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Section: Discussionmentioning

confidence: 93%

Transfusion for Shock in US Military War Casualties With and Without Tourniquet Use

Kragh¹,

Nam²,

Berry³

et al. 2015

Annals of Emergency Medicine

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“…For the critical outcome of mortality, we identified lowquality evidence (downgraded for risk of bias) from 3 human studies 118,124,125 with a comparison group enrolling 1768 patients showing no difference, where 12% of patients who had a tourniquet applied (91/791) died compared with 9% of patients who did not have a tourniquet applied (89/977) (RR, 1.08; 95% CI, 0.82-1.43) and 7 very-low-quality evidence (downgraded for risk of bias) human case series [120][121][122][126][127][128][129] enrolling 903 patients, where 10% of those patients who had a tourniquet applied (92/903) died.…”

Section: Consensus On Sciencementioning

confidence: 99%

“…For the critical outcome of vital signs, we identified lowquality evidence (downgraded for risk of bias) from 3 human studies with a comparison group 118,124,125 enrolling 1642 participants demonstrating no benefit, with an MD in HR of 3 BPM more (95% CI, 0.21-6.91) if a tourniquet was applied, and low-quality evidence (downgraded for risk of bias and imprecision) from 2 human studies with a comparison group 118,124 enrolling 284 participants demonstrating no benefit, with an MD in SBP of 9 mm Hg less (95% CI, −14.13 to −3.43) if a tourniquet was applied.…”

Section: Consensus On Sciencementioning

confidence: 99%

Part 9: First Aid

Em¹,

Da²,

Buck³

et al. 2015

Circulation

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and curriculum development, and a specialist in first aid evidence evaluation methodology and guideline development.The task force convened in June 2013 to review the topics and questions that were evaluated in 2005 and 2010, past research questions formulated in the PICO style (population, intervention, comparator, outcomes) that were never completed, and the new questions that had been submitted since 2010 to the task force, and a priority list created. Topics were reviewed for areas of controversy, known additional new science, and subject matter not previously evaluated. Task force members created a priority list for review, and the top 10 priority-ranked PICO questions were assigned. After the successful commencement of the workflow, the task force co-chairs added a further 12 PICO questions, including 5 new questions, 1 derived question, and 6 that had been previously reviewed. Selected PICO questions that had been previously reviewed were, in some cases, reworded to facilitate literature searches, and outcomes were decided upon by group consensus.Evidence reviewers were recruited through a call for volunteers distributed by ILCOR to stakeholder organizations around the world. More than 30 individual reviewers were assigned to topics, usually by preference or expertise, but avoiding any direct conflicts of interest. In general, 2 evidence reviewers were assigned to each PICO, supervised by a member of the task force designated as the task force question owner. Evidence reviewers included physicians with diverse specialties including emergency medicine, EMS, wilderness medicine, critical care, cardiology, occupational medicine, toxicology, anesthesia, pediatric emergency medicine, public health, and epidemiology, as well as paramedics, nurse practitioners and first aid education specialists with experience in guideline and curriculum development, and professional evidence evaluation and methodology experts. The Evidence Evaluation ProcessFor the 2015 international evidence evaluation process, the AHA developed a new Web-based information and documentation platform, the Systematic Evidence Evaluation and Review System (SEERS), to support the ILCOR systematic reviews and to capture the data in reusable formats. This Webbased system facilitated structured reviews in a consistent format that would support the ultimate development of science summaries and evidence-based treatment recommendations.Each task force performed a detailed systematic review based on the recommendations of the Institute of Medicine of the National Academies, 1 using the methodological approach proposed by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group.2 After identifying and prioritizing the PICO questions to be addressed, 3 and with the assistance of information specialists, a detailed search for relevant articles was performed in each of 3 online databases (PubMed, Embase, and the Cochrane Library).By using detailed inclusion and exclusion criteria, articles were screened for further evalu...

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“…Beim Militär gehören Tourniquets seit vielen Jahren zur Ausrüstung für die Behandlung von stark blutenden Extremitätenverletzungen [880,881]. Ihr Einsatz hat zu einer Reduktion der Sterblichkeit geführt [880][881][882][883][884][885][886][887][888][889]. Benutzen Sie bei stark blutenden Wunden an einer Extremität, die durch direkten Druck allein nicht kontrollierbar sind, ein Tourniquet.…”

Section: Einsatz Eines Tourniquet (Abbindung)unclassified