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Survival With Emergency Tourniquet Use to Stop Bleeding in Major Limb Trauma

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

doi: 10.1097/SLA.0b013e31818842ba

Objective: The purpose of this study was to determine if emergency tourniquet use saved lives.

Summary Background Data: Tourniquets have been proposed as lifesaving devices in the current war and are now issued to all soldiers. Few studies, however, describe their actual use in combat casualties.

Methods: A prospective survey of injured who required tourniquets was performed over 7 months in 2006 (NCT00517166 at Follow-up averaged 28 days. The study was at a combat support hospital in Baghdad. Among 2838 injured and admitted civilian and military casualties with major limb trauma, 232 (8%) had 428 tourniquets applied on 309 injured limbs. We looked at emergency tourniquet use, and casualties were evaluated for shock (weak or absent radial pulse) and prehospital versus emergency department (ED) tourniquet use. We also looked at those casualties indicated for tourniquets but had none used. We assessed survival rates and limb outcome.

Results: There were 31 deaths (13%). Tourniquet use when shock was absent was strongly associated with survival (90% vs. 10%; P < 0.001). Prehospital tourniquets were applied in 194 patients of which 22 died (11% mortality), whereas 38 patients had ED application of which 9 died (24% mortality; P = 0.05). The 5 casualties indicated for tourniquets but had none used had a survival rate of 0% versus 87% for those casualties with tourniquets used (P < 0.001). Four patients (1.7%) sustained transient nerve palsy at the level of the tourniquet. No amputations resulted solely from tourniquet use.

Conclusions: Tourniquet use when shock was absent was strongly associated with saved lives, and prehospital use was also strongly associated with lifesaving. No limbs were lost due to tourniquet use. Education and fielding of prehospital tourniquets in the military environment should continue.

Military investigators report a survival benefit in patients with major limb trauma with emergency tourniquets used in hemorrhage control. In both prehospital and hospital settings, survival rates were better in patients with tourniquets used and when tourniquets were used before shock onset.

From the *US Army Institute of Surgical Research, Fort Sam Houston, TX; and †Walter Reed Army Medical Centre, Georgia Avenue North West, Washington DC.

Study performed at 10th Combat Support Hospital, US Army Task Force North, APO AE 09348 (Ibn Sina Hospital, International Zone, Baghdad, Iraq).

COL Kragh conceived and designed the work, collected the data, analyzed data, and produced the article. Drs Walters and Baer participated in conception, design, and writing. MAJ Fox, Dr Wade, and COL Holcomb participated in data collection, analysis, and writing. Dr Salinas participated in design, analysis, and writing. Drs Wade, Baer, and COL Kragh participated in the regulatory oversight.

The funding of this work was only for the general salary of the investigators in the course of their federal employment. There was no sponsor and the authors declare no conflicts of interest.

No reprints are available from the authors. There was no grant; the work was supported by US Army internal funds. We consult at no cost with tourniquet companies that engage us on design improvements. We have cooperative research and development agreements and material transfer agreements with such companies that protect intellectual property rights and the like.

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.

© 2009 Lippincott Williams & Wilkins, Inc.