Tourniquet use in childhood: a harmless procedure?

Area of Science:

• Pediatric Surgery
• Vascular Surgery
• Thrombosis Research

Background:

• Tourniquet ischemia is a common practice in limb surgeries across all age groups.
• While deep vein thrombosis and pulmonary embolism are known adult complications, they are generally considered low-risk in healthy children.
• Current guidelines recommend antithrombotic prophylaxis only for children with specific risk factors, excluding routine use in obese, otherwise healthy children.

Observation:

• A case report details a fatal pulmonary thromboembolism in a 12-year-old obese boy (BMI 27.6 kg/m²).
• The event occurred after tourniquet deflation following a minor lower extremity surgery.
• This represents the first documented instance of fatal pulmonary embolism in this demographic following tourniquet application.

Findings:

• Tourniquet application, even in minor pediatric surgery, can precipitate life-threatening thromboembolic events.
• Obesity may represent a significant, previously underestimated risk factor for tourniquet-associated complications in children.
• Alterations in blood clotting physiology due to tourniquet ischemia may have clinical relevance in certain pediatric populations.

Implications:

• The findings challenge the assumption of negligible clinical impact of tourniquet-associated clotting changes in all children.
• There is a need to reconsider and potentially revise current guidelines for antithrombotic prophylaxis in pediatric surgery, particularly for obese children.
• This case underscores the importance of vigilant monitoring and risk assessment in pediatric patients undergoing surgery with tourniquet application.