Pre-Hospital Tourniquets Linked to Mortality Reduction

Tourniquets placed by civilians to stem peripheral vascular injury (PVI) are associated with a six-fold mortality reduction, according to a new study.

Researchers at the University of Texas (UT, Austin, USA), Baylor College of Medicine (Houston, TX, USA), and other institutions conducted a multicenter retrospective review of 1,026 patients who sustained PVI from January 2011 to December 2016, and who were admitted to 11 Level I trauma centers. The study population was divided into two groups, based on pre-hospital tourniquet use. The researchers then evaluated the association between pre-hospital tourniquet use and mortality, with delayed amputation serving as the secondary end point.

The results revealed that during the six-year period, pre-hospital tourniquets were used in 17.6% of the patients. Mortality was 5.2% in the non-tourniquet group, compared with 3.9% in the tourniquet group. Tourniquet time averaged 77.3 minutes, and traumatic amputations occurred in 98 patients, of whom 35.7% had a tourniquet. Analysis revealed that tourniquet use independently associated with increased survival, and that delayed amputation rates were not significantly different between the two groups. The study was published on March 29, 2018, in the Journal of the American College of Surgeons (JACS).

“Although still underused, civilian pre-hospital tourniquet application was independently associated with a six-fold mortality reduction in patients with peripheral vascular injuries,” concluded lead author Pedro Teixeira, MD, from UT Austin, and colleagues. “Tourniquet use has been proven to reduce mortality on the battlefield; more aggressive pre-hospital application of tourniquets in civilian trauma patients with extremity hemorrhage and traumatic amputation is warranted.”

A tourniquet is a constricting or compressing device used to control blood flow to an extremity for a period of time. Pressure is applied circumferentially around a portion of a limb at a desired location; this pressure is transferred to the walls of blood vessels, causing them to become temporarily occluded or restricted. In emergency settings, a tourniquet is used stop traumatic bleeding so that medical care can be provided in time before, the injured person exsanguinates.

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University of Texas
Baylor College of Medicine