Limb complications following pre-hospital tourniquet use

It has been stated that the application of a pre-hospital tourniquet could prevent 7% of combat deaths, however their widespread use has been questioned due to the potential risk from prolonged ischaemia. We reviewed members of the UK Armed Forces who sustained severe limb-threatening injuries in Iraq and Afghanistan, and performed a matched cohort study based on the presence or absence of pre-hospital tourniquet application. When a pre-hospital tourniquet had been applied, 19/22 patients had a least one complication compared to 15/22 where no tourniquet had been applied [p = 0.13]. There were 10 limbs with at least one major complication in the pre-hospital tourniquet group but only four in the group with no tourniquet [p = 0.045]. The significant difference in the incidence of major complications is a concern, particularly as the difference was mainly due to a deep infection rate of 32% vs. 4.5%. Although a number of variables could have influenced these small groups, such as choice of fracture fixation implant and method and timing of wound closure, the use of a matched cohort study design with a statistical significance level of p < 0.05, suggests the use of a pre-hospital tourniquet as a factor. Although the use of pre-hospital tourniquets cannot be decried as a result of this study, the need to continually prospectively review their use to determine their risk/benefit ratio remains.