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A multi-institutional analysis of prehospital tourniquet use

Schroll, Rebecca MD; Smith, Alison MD, PhD; McSwain, Norman E. Jr. MD, NREMT-P; Myers, John MD; Rocchi, Kristin RN; Inaba, Kenji MD; Siboni, Stefano MD; Vercruysse, Gary A. MD; Ibrahim-zada, Irada MD, PhD; Sperry, Jason L. MD, MPH; Martin-Gill, Christian MD; Cannon, Jeremy W. MD, SM; Holland, Seth R. PA; Schreiber, Martin A. MD; Lape, Diane; Eastman, Alexander L. MD, MPH; Stebbins, Cari S. MPH; Ferrada, Paula MD; Han, Jinfeng RN; Meade, Peter MD, MPH; Duchesne, Juan C. MD

Journal of Trauma and Acute Care Surgery: July 2015 - Volume 79 - Issue 1 - p 10–14
doi: 10.1097/TA.0000000000000689
EAST 2015 Plenary Papers
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BACKGROUND Recent military studies demonstrated an association between prehospital tourniquet use and increased survival. The benefits of this prehospital intervention in a civilian population remain unclear. The aims of our study were to evaluate tourniquet use in the civilian population and to compare outcomes to previously published military experience. We hypothesized that incorporation of tourniquet use in the civilian population will result in an overall improvement in mortality.

METHODS This is a preliminary multi-institutional retrospective analysis of prehospital tourniquet (MIA-T) use of patients admitted to nine urban Level 1 trauma centers from January 2010 to December 2013. Patient demographics and mortality from a previous military experience by Kragh et al. (Ann Surg. 2009;249:1–7) were used for comparison. Patients younger than 18 years or with nontraumatic bleeding requiring tourniquet application were excluded. Data were analyzed using a two-tailed unpaired Student’s t test with p < 0.05 as significant.

RESULTS A total of 197 patients were included. Tourniquets were applied effectively in 175 (88.8%) of 197 patients. The average Injury Severity Score (ISS) for MIA-T versus military was 11 ± 12.5 versus 14 ± 10.5, respectively (p = 0.02). The overall mortality and limb amputation rates for the MIA-T group were significantly lower than previously seen in the military population at 6 (3.0%) of 197 versus 22 (11.3%) of 194 (p = 0.002) and 37 (18.8%) of 197 versus 97 (41.8%) of 232 (p = 0.0001), respectively.

CONCLUSION Our study is the largest evaluation of prehospital tourniquet use in a civilian population to date. We found that tourniquets were applied safely and effectively in the civilian population. Adaptation of this prehospital intervention may convey a survival benefit in the civilian population.

LEVEL OF EVIDENCE Epidemiologic study, level V.

From the Department of Surgery (R.S., A.S., N.E.M.), Tulane University School of Medicine, New Orleans, Louisiana; Department of Surgery (J.M., K.R.), University of Texas Health Sciences Center, San Antonio, Texas; Department of Surgery (K.I., S.S.), University of Southern California Medical Center, Los Angeles, California; Department of Surgery (G.A.V., I.I.-Z.), University of Arizona Medical Center, Tucson, Arizona; Departments of Surgery (J.L.S.) and Emergency Medicine (C.M.-G.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Surgery (J.W.C., S.R.H.), San Antonio Military Medical Center, San Antonio, Texas; Department of Surgery (J.W.C.), Uniformed Services University of the Health Sciences, Bethesda, Maryland; Department of Surgery (M.A.S., D.L.), Oregon Health and Science University, Portland, Oregon; Department of Surgery (A.L.E., C.S.S.), University of Texas Southwestern/Parkland Memorial Hospital, Dallas, Texas; Department of Surgery (P.F., J.H., P.M., J.C.D.), Virginia Commonwealth University, Richmond, Virginia.

Submitted: December 1, 2014, Revised: February 2, 2015, Accepted: February 6, 2015.

This study was presented at the 28th Annual Scientific Assembly of the Eastern Association for the Surgery of Trauma, January 13–17, 2015, in Lake Buena Vista, Florida.

Address for reprints: Rebecca Schroll, MD, Tulane University School of Medicine, 1430 Tulane Ave, SL-22, New Orleans, LA 70112; email: rschroll@tulane.edu.

© 2015 Lippincott Williams & Wilkins, Inc.