Tourniquets in the Era of “Stop the Bleed”—Are Simple Pressure Maneuvers Being Bypassed for Tourniquets in Non-arterial Bleeding?

Abstract

Aim: Tourniquets are a well-studied method of temporary hemostasis for life-threatening bleeding. Previous studies place the rate of true arterial injuries among applied tourniquets in civilian populations between 44% and 70.1%. Materials and methods: We conducted a single center, retrospective, case-control study of all patients with prehospital applied tourniquet between May 2016 and November 2017. Criteria for true arterial injury were traumatic amputation or arterial injury requiring immediate surgery. We pooled reported civilian data to be utilized as a reference population. Results: In an 18-month period, 66 patients presented with tourniquets. True arterial injury existed in 36% vs 53% in the reference population (chi square = 7.3, p = 0.0068). There was no significant difference between blunt vs penetrating mechanism (35% vs 37%, p = 0.85). Gun-shot wounds (GSW) were more likely to have no arterial injury than all other injury types (81% vs 56%, p = 0.046, OR = 3.4). There was no significant difference in tourniquet application between paramedics and other first responders (74% vs 75%, p = 0.48). Conclusion:Injury type appears to be a factor; in patients with a tourniquet, those with a GSW were 3.4 times as likely to have no arterial injury as other injury types. This data reflects a high frequency of prehospital tourniquet application without arterial injury. Multi-institutional, prospective studies are necessary to evaluate tourniquet utilization.