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Effectiveness of the combat application tourniquet for arterial occlusion in young children
Joseph R Kelly1, Matthew J Levy, Jose Reyes
1From the Johns Hopkins Hospital (J.R.K., M.J.L., J.A.); and Johns Hopkins University School of Medicine (J.R.), Baltimore, Maryland.
Insights
The Combat Application Tourniquet (CAT) effectively controls extremity hemorrhage in children as young as two years old. This study demonstrates high success rates for pediatric tourniquet use in emergency situations.
Area of Science:
- Pediatric Trauma Care
- Emergency Medicine
- Surgical Procedures
Background:
- Tourniquet use is standard for adult extremity hemorrhage but lacks pediatric research.
- Increased civilian tourniquet availability necessitates understanding pediatric application.
- This study addresses the gap in knowledge regarding pediatric tourniquet efficacy.
Purpose of the Study:
- To determine the minimum age for effective Combat Application Tourniquet (CAT) use in pediatric extremity hemorrhage control.
- To evaluate the efficacy of the CAT in a pediatric population.
- To provide evidence for the safe and effective use of tourniquets in children.
Main Methods:
- Enrolled pediatric patients aged 1-8 years undergoing elective orthopedic surgery.
- Measured patient demographics including age, weight, height, and limb circumferences.
- Applied CAT to upper and lower limbs under anesthesia, assessing for pulse obliteration via Doppler, and recorded success rates.
Main Results:
- Thirteen children aged 2-7 years were included in the study.
- The CAT achieved 100% arterial occlusion in all tested extremities (11 arms, 13 legs).
- Successful occlusion was achieved across a range of pediatric weights and limb circumferences.
Conclusions:
- The CAT is effective in achieving arterial occlusion in preschool-aged children.
- Results suggest the CAT can be successfully used for severe extremity hemorrhage in school-aged children.
- This study provides the first evidence of commercial tourniquet efficacy in young children.
Background:
Tourniquet use for extremity hemorrhage has become a mainstay in adult trauma care in last 15 years. The efforts of the Stop the Bleed campaign have increased the distribution and use of tourniquets in civilian settings in response to mass shootings and as part of disaster preparedness. Little research or published experience exists regarding the use of tourniquets in the pediatric population. This study sought to determine the minimum patient age on which the combat application tourniquet (CAT) is able to control extremity hemorrhage.
Methods:
A convenience sample of pediatric patients, ages 1 year to 8 years, scheduled for elective orthopedic surgery at an academic hospital, were eligible for enrollment. Subject age, weight, height, blood pressure, and arm and leg circumferences were obtained. Once under general anesthesia, the pulse of an upper and a lower limb were obtained by Doppler, a CAT was then placed at the most proximal practical location of the limb until the corresponding pulse was either no longer obtainable by Doppler or until the tourniquet was as tight as its design allows. The tourniquet was removed after 30 seconds of arterial occlusion.
Results:
Thirteen children, ages 2 years to 7 years were enrolled. Weights ranged from 12.8 kg to 23.9 kg, with a mean of 16.7 kg. Leg circumferences were 24.5 cm to 34.5 cm, with a mean of 27.9 cm and arm circumferences were 13 cm to 24 cm, with a mean of 16.3 cm. Subject heights were 87 cm to 122 cm, with a mean of 103.4 cm. Twenty-four total extremities were tested, 11 arms and 13 legs. Arterial occlusion was obtained on 100% of limbs tested (95% confidence interval, 85.8-100%).
Conclusion:
This study is similar to previous adult tourniquet efficacy studies in design, size and outcomes. It is the first to show successful arterial occlusion on preschool-aged children with a commercial tourniquet in a controlled setting. The results suggest that the CAT can be used in school-aged children with severe extremity hemorrhage with a high likelihood of success.
Level Of Evidence:
Therapeutic, level II.
