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Prehospital Tourniquets in Civilians: A Systematic Review
Kenneth A Eilertsen1, Morten Winberg1, Elisabeth Jeppesen2,3
1University of Oslo, Oslo, Norway.
Prehospital and Disaster Medicine
|November 3, 2020
Summary
Prehospital tourniquet use for severe extremity bleeding in civilians appears to improve survival rates and reduce blood transfusions. While evidence quality is low, findings consistently suggest benefits with few transient adverse effects.
Area of Science:
- Emergency Medicine
- Trauma Surgery
- Public Health
Background:
- Civilian mass-casualty events and terrorist attacks frequently cause uncontrollable extremity bleeding.
- Prehospital tourniquet application is increasingly adopted in civilian settings for life-threatening hemorrhages.
Purpose of the Study:
- To systematically review and summarize existing literature on prehospital tourniquet use in civilian settings.
- To assess the impact of tourniquet use on survival rates in patients with critical extremity hemorrhage.
Main Methods:
- A systematic literature review was conducted following PRISMA guidelines.
- Searches included Medline, Embase, Cochrane Library, and Epistemonikos up to January 2019.
- Studies published after January 1, 2000, examining prehospital tourniquet use were included.
Main Results:
- 55 studies were identified from 3,460 screened records, exhibiting high heterogeneity and low evidence quality.
- Most studies indicated increased survival in the tourniquet group, though precise benefit estimation was challenging.
- Reduced need for blood transfusions was commonly reported, alongside few, mostly transient, adverse effects.
Conclusions:
- Despite limitations in evidence quality, prehospital tourniquet use in civilian settings for life-threatening extremity hemorrhage is consistently associated with improved survival.
- Tourniquet application appears to reduce the need for blood transfusions.
- Adverse effects associated with tourniquet use are generally minimal and transient.
