Abstract
Survival with Emergency Tourniquet Use to Stop Bleeding in Major Limb Trauma
(Annals of Surgery. 2009;249:489–497) JF Kragh, TJ Walters, DG Baer, et al
Prepared by Anil Menon, MD, Stanford Wilderness Medicine Fellow, Stanford, CA, USA
Standard treatment in active combat zones has reversed the traditional “A, B, C” approach to trauma and addresses circulation first. On the battlefield, severe extremity hemorrhaging is managed with a tourniquet. This study looked at a larger than previously studied population of trauma patients treated with tourniquets to assess the utility of this treatment.
The authors conducted a prospective study of 232 patients treated at a combat support hospital in Baghdad named Ibn Sina. Between March and October of 2006 the study included all patients who had a tourniquet applied and accounted for 8% of all trauma admissions during this timeframe. A total of 428 tourniquets were applied. Through a subgroup analysis based on age, sex, injury severity score, and abbreviated injury scales the authors found that tourniquet use prior to the onset of shock led to a survival rate of 90% and only 10% when they were not used. They also showed a complication rate of only 1.7% attributable to tourniquet use, with all of these being transient nerve palsies that resolved in less than one week. The average duration of tourniquet use was under 2 hours.
An interesting facet of this study was the low complication rate, which might make tourniquets more acceptable in other pre-hospital settings such as a wilderness environment—though the authors did not make this generalization. Limitations to this study include a specific population where 63% of injuries were blast wounds and a small control group derived from subgroup analysis (13 patients). Also, the study indicates that although all of the medics were trained by and serving in the military, they may have confounded the control group through variations in their medical knowledge or treatment.