Prolonged tourniquet use in extremity trauma: What you need to know

Routine tourniquet use has significantly improved early survival in both military and civilian settings for extremity hemorrhage in trauma patients. However, most supporting evidence revolves around short-duration tourniquet use stemming from trauma systems with rapid evacuation and early surgical care. Emerging military operations and austere civilian settings risk prolonged prehospital times, introducing uncertainty in the management of prolonged tourniquet application. These scenarios present high-risk situations for medical providers and potentially life-threatening complications for patients. Despite this, management strategies during these scenarios remain poorly defined. This review synthesizes current military and civilian literature to address key challenges in prolonged ischemia, including tourniquet conversion, decision-making surrounding limb salvage versus early amputation, and the pathophysiology and management of ischemia reperfusion injury.