17.20 Myth Busting: The Use of Makeshift Tourniquets In Extremity Vascular Trauma

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.