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. 2021 Feb;36(1):86-94.
doi: 10.1017/S1049023X20001284. Epub 2020 Nov 3.

Prehospital Tourniquets in Civilians: A Systematic Review

Kenneth A Eilertsen #  1 , Morten Winberg #  1 , Elisabeth Jeppesen  2   3 , Gyri Hval  4 , Torben Wisborg  5   6   7
Affiliations

Prehospital Tourniquets in Civilians: A Systematic Review

Kenneth A Eilertsen et al. Prehosp Disaster Med. 2021 Feb.

Abstract

Objectives: Terrorist attacks and civilian mass-casualty events are frequent, and some countries have implemented tourniquet use for uncontrollable extremity bleeding in civilian settings. The aim of this study was to summarize current knowledge on the use of prehospital tourniquets to assess whether their use increases the survival rate in civilian patients with life-threatening hemorrhages from the extremities.

Design: Systematic literature review in Medline (Ovid), Embase (Ovid), Cochrane Library, and Epistemonikos was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. The search was performed in January 2019.

Setting: All types of studies that examined use of tourniquets in a prehospital setting published after January 1, 2000 were included.

Primary/secondary outcomes: The primary outcome was mortality with and without tourniquet, while adverse effects of tourniquet use were secondary outcomes.

Results: Among 3,460 screened records, 55 studies were identified as relevant. The studies were highly heterogeneous with low quality of evidence. Most studies reported increased survival in the tourniquet group, but few had relevant comparators, and the survival benefit was difficult to estimate. Most studies reported a reduced need for blood transfusion, with few and mainly transient adverse effects from tourniquet use.

Conclusion: Despite relatively low evidence, the studies consistently suggested that the use of commercial tourniquets in a civilian setting to control life-threatening extremity hemorrhage seemed to be associated with improved survival, reduced need for blood transfusion, and few and transient adverse effects.

Keywords: first responder; hemorrhage; penetrating wounds; tourniquet.

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Figures

Figure 1.
Figure 1.
PRISMA Flow Diagram of the Selection of Included Studies.
Figure 2.
Figure 2.
Studies Reporting on Mortality, Excluding Case Reports and Studies with Less Than 20 Participants. Note: Circle size indicates the number of patients treated with tourniquet. The center of the circle indicates the survival rate. Each study is represented by its reference number.
See this image and copyright information in PMC

References

    1. Jacobs LM, Jr. The Hartford Consensus III: implementation of bleeding control. J Spec Oper Med. 2015;15(4):136-141. - PubMed
    1. Jacobs LM. The Hartford Consensus IV: a call for increased national resilience. Bull Am Coll Surg. 2016;101(3):17-24. - PubMed
    1. Jacobs LM, McSwain NE, Jr., Rotondo MF, et al. Improving survival from active shooter events: the Hartford Consensus. J Trauma Acute Care Surg. 2013;74(6):1399-1400. - PubMed
    1. Jacobs LM, Sinclair J, Rotondo M, et al. Active shooter and international mass-casualty events: The Hartford Consensus II. Bull Am Coll Surg. 2015;100(1 Suppl):35-39. - PubMed
    1. Gaarder C, Jorgensen J, Kolstadbraaten KM, et al. The twin terrorist attacks in Norway on July 22, 2011: the trauma center response. J Trauma Acute Care Surg. 2012;73(1):269-275. - PubMed

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