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Practical Use of Emergency Tourniquets to Stop Bleeding in Major Limb Trauma

Kragh, John F. Jr MD; Walters, Thomas J. PhD; Baer, David G. PhD; Fox, Charles J. MD; Wade, Charles E. PhD; Salinas, Jose PhD; Holcomb, John B. MC

Journal of Trauma-Injury Infection & Critical Care: February 2008 - Volume 64 - Issue 2 - pp S38-S50
doi: 10.1097/TA.0b013e31816086b1
Presented Papers

Background: Previously we showed that tourniquets were lifesaving devices in the current war. Few studies, however, describe their actual morbidity in combat casualties. The purpose of this study was to measure tourniquet use and complications.

Methods: A prospective survey of casualties who required tourniquets was performed at a combat support hospital in Baghdad during 7 months in 2006. Patients were evaluated for tourniquet use, limb outcome, and morbidity. We identified potential morbidities from the literature and looked for them prospectively. The protocol was approved by the institutional review board.

Results: The 232 patients had 428 tourniquets applied on 309 injured limbs. The most effective tourniquets were the Emergency Medical Tourniquet (92%) and the Combat Application Tourniquet (79%). Four patients (1.7%) sustained transient nerve palsy at the level of the tourniquet, whereas six had palsies at the wound level. No association was seen between tourniquet time and morbidity. There was no apparent association of total tourniquet time and morbidity (clots, myonecrosis, rigor, pain, palsies, renal failure, amputation, and fasciotomy). No amputations resulted solely from tourniquet use. However, six (2.6%) casualties with eight preexisting traumatic amputation injuries then had completion surgical amputations and also had tourniquets on for >2 hours. The rate of limbs with fasciotomies with tourniquet time ≤2 hours was 28% (75 of 272) and >2 hours was 36% (9 of 25, p = 0.4).

Conclusions: Morbidity risk was low, and there was a positive risk benefit ratio in light of the survival benefit. No limbs were lost because of tourniquet use, and tourniquet duration was not associated with increased morbidity. Education for early military tourniquet use should continue.

From the US Army Institute of Surgical Research (J.F.K., T.J.W., D.G.B., C.E.W., J.S., J.B.H.), Fort Sam Houston, Texas; and Walter Reed AMC (C.J.F.), Washington, DC.

Submitted for publication October 29, 2007.

Accepted for publication October 30, 2007.

The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the Department of Defense or United States Government. The authors are employees of the US Government. This work was prepared as part of their official duties and, as such, there is no copyright to be transferred.

Address for reprints: John F. Kragh, Jr., MD, USA Institute of Surgical Research, Bone and Soft Tissue Trauma Research Program, 3400 Rawley E. Chambers Avenue, Bldg. 3611, Room L82-16, Fort Sam Houston, TX 78234-6315; e-mail: john.kragh@amedd.army.mil.

© 2008 Lippincott Williams & Wilkins, Inc.