Precise Limb Tourniquet Arterial Occlusion Pressure Determination using Real-Time Ultrasonography and a
Jeffrey N Wood1,2, Benjamin S Krippendorf2, Craig A Blakeney1,2
1Division of Prehospital Care, Mayo Clinic, Rochester, Minnesota, USA.
Prehospital and Disaster Medicine
|October 18, 2022
Summary
Tourniquets (TQs) can save lives, but pulse checks alone don't guarantee arterial occlusion. This study found that ultrasound still detected flow even when pulses were absent, indicating TQs need further tightening for complete hemorrhage control.
Area of Science:
- Trauma care
- Vascular surgery
- Emergency medicine
Background:
- Hemorrhage control is critical before shock onset.
- Tourniquets (TQs) are life-saving interventions.
- Physiologic parameters for successful TQ application beyond pulse palpation are not well understood.
Purpose of the Study:
- To directly visualize distal arterial occlusion using ultrasonography.
- To measure associated pressure and contact force during TQ application.
- To compare TQ effectiveness based on pulse palpation versus ultrasound visualization.
Main Methods:
- Fifteen tactical officers served as live models.
- Arterial occlusion was achieved using a blood pressure cuff and a Combat Application Tourniquet (CAT7).
- Ultrasonography (US) and palpation assessed arterial flow cessation; force sensors measured contact force.
Main Results:
- A mean systolic blood pressure (SBP) of 112.9 mmHg and 23.8 N force occluded palpable pulses.
- Despite absent pulses, 100% of subjects showed arterial flow via US.
- Eliminating US flow required a mean SBP of 132 mmHg and 27.7 N force, with an average of 1.6 windlass turns.
Conclusions:
- Loss of a distal radial pulse does not confirm complete arterial flow cessation with upper extremity TQs.
- An average of one-quarter additional windlass turn is needed to eliminate distal flow.
- Study data can inform future TQ design and training model development.
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