E. M. Campion1, V. Orr2, A. Conroy2, J. Gurney2, M. J. Cohen2, R. Callcut2 1Denver Health Medical Center,Surgery,Denver, CO, USA 2University Of California – San Francisco,Surgery,San Francisco, CA, USA
Introduction: Recent military experience with tourniquets has demonstrated safety and efficacy with few complications. These studies have increased enthusiasm for civilian use. Civilian data has lacked injury specifics and many remain concerned about the potential downside to overuse. Using a standard protocol for documenting duration of tourniquet use, this study investigates outcomes following prehospital tourniquet application.
Methods: A retrospective review was performed for prehospital tourniquet application in a metropolitan trauma system from 2011 to 2014. Demographics, injury details, sensorimotor exam, transfusion data, operative treatment, complications and outcome were analyzed. The need for a tourniquet was deemed appropriate if a major artery was injured or the attending trauma surgeon reapplied the tourniquet in the emergency room for significant bleeding.
Results: 38 patients with a total of 39 extremities had tourniquets applied. 1 patient died (3%). Median transport time was 8 minutes. Median ischemia time from placement to removal in ED or OR was 49 minutes. 3 (8%) patients had a prehospital amputation and 4 (11%) had partial amputations. A systolic blood pressure<90 occurred in 9 (26%) prehospital and 12 (32%) in the ED. 5 (14%) required a massive transfusion. 18 (47%) had major arterial injury and 15 (40%) major venous injury. 30 (79%) required emergency surgery with 2 (5%) undergoing fasciotomy. Tourniquets were deemed appropriate in 16 (42%), likely inappropriate in 14 (37%) and questionable in 8 (21%). 17 (47%) patients survived with intact sensation. 11 (31%) survived with a sensation or motor deficit, and 7 (19%) required amputation. No complication could be definitively linked to tourniquet use.
Conclusion: Tourniquet placement in the civilian setting is associated with a high rate of major arterial or venous injury, with a significant majority of patients requiring emergency surgery. Tourniquet application was safe, as we did not identify a single case in which harm could be attributed to tourniquet use. However, further education of prehospital providers is warranted as we identified a number of patients with tourniquets in which there was no clear indication for their use.