A. A. Haider1, B. Joseph1, A. Hassan1, N. Kulvatunyou1, T. O’Keeffe1, A. Tang1, R. Latifi1, G. Vercruysse1, D. J. Green1, R. S. Friese1, P. Rhee1 1University Of Arizona,Trauma Surgery,Tucson, AZ, USA
Introduction: Tourniquets are life saving devices and its practice has extended to the civilian setting. Improvised or makeshift tourniquets are frequently applied after extremity vascular trauma however; inappropriate application of a non-standardized tourniquet may incompletely occlude arterial inflow and worsen bleeding. The aim of this study was to assess the effectiveness of makeshift tourniquets after extremity trauma.
Methods: We performed a 5-year retrospective analysis of all trauma patients presenting to our level I trauma center with an extremity vascular injury. We matched patients who arrived with a non-standardized/makeshift tourniquet applied to those who arrived without a tourniquet using propensity score matching in a 1:1 ratio controlling for age, gender, mechanism of trauma, region of vascular injury (arm, forearm, thigh leg), operative intervention, Injury Severity Score (ISS), and Extremity Injury Severity Score (Ext-AIS). Primary outcome measure was transfusion requirement; secondary outcome measures were hemodynamic parameters on arrival, admission hemoglobin, complications (wound infection, ischemic, re-bleeding), amputation rate, and nerve deficits.
Results:A total of 66 patients (No-Tourniquet: 33, Tourniquet: 33) were included. There was no difference in age (p=0.4), gender (p=0.7), ISS (p=0.8), Ext-AIS (p=0.8), thoracic AIS (p=0.74), mechanism of trauma (p=0.8) and region of vascular injury (arm p=0.7, forearm p=1.0, thigh p=1.0, and leg p=1.0) between the two groups. Outcomes are shown below in Table 1.
Conclusion:Although tourniquets are life saving devices, the use of non-standardized tourniquets is associated with greater blood transfusion requirement. The practice of non-standardized tourniquet use in extremity vascular trauma should be discouraged.
