Prehospital Tourniquets Reduce PRBCs and Save Limbs

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Prehospital use of tourniquets (TQ) for extremity trauma markedly reduced transfusion requirement and likely also reduced the need for fasciotomy or amputation.

Why does this matter?
Recent mass shootings and the Stop the Bleed campaign have increased awareness for TQ use. We know TQs save lives in a military setting. But does TQ use really make a clinically important difference in a civilian setting?

Tourniquets save limbs and red cells
This was a case-control study from a single center. They found 127 patients with compressible bleeding who had a commercial TQ applied in the prehospital setting due to penetrating extremity trauma and matched them to 77 otherwise similar patients who did not have a TQ applied at any point. Most had the TQ on for just over 20 minutes upon arrival to the ED. For the primary outcome of PRBC transfusion, the TQ group received just 2 units vs 9.3 in the non-TQ group. The TQ patients also arrived with a higher SBP and required fewer fasciotomies and amputations than the non-TQ patients. TQ was not associated with an increased risk of nerve palsies or greater infection risk. One of the main concerns about civilian TQ use has been nerve injury and ischemic limb complications. This study’s results are reassuring in that regard. There is a possibility for confounding given the retrospective design, but the results are consistent with prior military studies of TQ use.

Source
Pre-hospital tourniquet use in penetrating extremity trauma: decreased blood transfusions and limb complications. J Trauma Acute Care Surg. 2018 Oct 23. doi: 10.1097/TA.0000000000002095. [Epub ahead of print]

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