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Tourniquet usage in prehospital care and resuscitation of pediatric trauma patients—Pediatric Trauma Society position statement

Cunningham, Aaron, MD; Auerbach, Marc, MD; Cicero, Mark, MD; Jafri, Mubeen, MD

Journal of Trauma and Acute Care Surgery: October 2018 - Volume 85 - Issue 4 - p 665–667
doi: 10.1097/TA.0000000000001839
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BACKGROUND Recent mass casualty events in the United States have highlighted the need for public preparedness to prevent death from uncontrolled hemorrhage. The Pediatric Trauma Society (PTS) reviewed the literature regarding pediatric tourniquet usage with the aim to provide recommendations about the utility of this adjunct for hemorrhage control in children.

METHODS Search terms “pediatric” and “tourniquet” were used to query the US National Library of Medicine National Institutes of Health for pertinent literature. Exclusion criteria include not involving children, not involving the use of an extremity tourniquet, primary outcomes not related to hemorrhage control, tourniquet use to prevent snake envenomation, single case reports, and only foreign language formats available. Bibliographies of remaining studies reviewed to identify additional pertinent research. Four physician members of the PTS Guidelines Committee reviewed identified studies.

RESULTS One hundred thirty-four studies were identified. One hundred twenty-three studies were excluded. Seven additional studies were identified through bibliography review. Eighteen pertinent studies were reviewed. Seven articles evaluated physiologic response to tourniquet use in operating room settings. Six articles were generated from combat experience in conflicts in Afghanistan and Iraq. Four articles discussed technical details of tourniquet usage. One article evaluated the use of tourniquets during the Boston Marathon bombing in 2015.

CONCLUSION Despite limited data of limited quality regarding their use, the PTS supports the usage of tourniquets in the prehospital setting and during the resuscitation of children suffering from exsanguinating hemorrhage from severe extremity trauma. Expedited, definitive care must be sought, and tourniquet pressure and time should be limited to the least amount possible. The Society supports the ACS “Stop the Bleed” campaign and encourages further investigation of tourniquet use in children.

LEVEL OF EVIDENCE Guidelines/algorithm study, level IIIa.

From the Department of Surgery (A.C.), Oregon Health and Science University, Portland, Oregon; Department of Emergency Medicine (M.A., M.C.), Yale New Haven Children’s Hospital, New Haven, Connecticut; and Division of Pediatric Surgery (M.J.), Doernbecher Children’s Hospital, Oregon Health and Science University, Randall Children’s Hospital at Legacy Emanuel, Portland, Oregon.

Submitted: November 8, 2017, Revised: January 15, 2018, Accepted: January 26, 2018, Published online: February 20, 2018.

Address for reprints: Mubeen Jafri, MD, Division of Pediatric Surgery, Oregon Health Science University, 3181, SW Sam Jackson Park Rd., Mailcode: CDW 7, Portland, OR 97239; email:

Presented at the 4th Annual Meeting of the Pediatric Trauma Society, November 4, 2017 in Charleston, SC.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (

© 2018 Lippincott Williams & Wilkins, Inc.