Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Apr 13;13(4):e14474.
doi: 10.7759/cureus.14474.

Appropriate Tourniquet Types in the Pediatric Population: A Systematic Review

Nathan P Charlton  1 , Craig A Goolsby  2 , David A Zideman  3 , Ian K Maconochie  4 , Peter T Morley  5 , Eunice M Singletary  1
Affiliations
Review

Appropriate Tourniquet Types in the Pediatric Population: A Systematic Review

Nathan P Charlton et al. Cureus. .

Abstract

Trauma is the leading cause of mortality in those aged 1-19, with hemorrhage accounting for up to 40% of all trauma deaths. Manufactured tourniquets are recommended for the control of life-threatening extremity hemorrhage in adults but their use in the pediatric population requires further investigation. We performed a systematic review to evaluate the most appropriate tourniquet design for use in the pediatric population. A literature search of Embase and the Cochran databases of trials and systematic reviews on October 1, 2020 identified 454 unique references, of which 15 were included for full-text screening. Two single-arm observational studies with a high risk of bias evaluated the use of windlass tourniquets in the pediatric population (73 patients, age 2-16 years). The certainty of the evidence was very low. In both studies, conducted on uninjured extremities, the use of a manufactured windlass tourniquet, specifically the Combat Application Tourniquet (C-A-T®) Generation 7, led to the cessation of Doppler detected pulses in 71/71 (100%) of upper extremities and 69/73 (94.5%) of lower extremities. Of the four failures, one participant withdrew due to pain and three tourniquet applications failed to occlude pulses after three turns of the windlass. No controls were used for comparison. In conclusion, two observational studies demonstrated that windlass tourniquets were able to abolish distal pulses in children as young as two years of age and with a minimum limb circumference of 13 cm. These preliminary findings may be helpful for organizations in the creation of guidelines for the management of life-threatening extremity bleeding in children.

Keywords: bleeding; first-aid; hemorrhage; pediatric; tourniquet.

PubMed Disclaimer

Conflict of interest statement

Disclaimer for Dr Craig Goolsby: This article is the opinion of the authors and does not reflect the official policy or position of the Uniformed Services University, Defense Department, or US Government.

Figures

Figure 1
Figure 1. Flow Diagram for the Pediatric Tourniquet Systematic Review
See this image and copyright information in PMC

References

    1. Leading causes of fatal and nonfatal unintentional injury for children and teens and the role of lifestyle clinicians. Dellinger A, Gilchrist J. Am J Lifestyle Med. 2019;13:7–21. - PMC - PubMed
    1. Impact of hemorrhage on trauma outcome: an overview of epidemiology, clinical presentations, and therapeutic considerations. Kauvar DS, Lefering R, Wade CE. J Trauma. 2006;60:0–11. - PubMed
    1. Epidemiology of trauma deaths: a reassessment. Sauaia A, Moore FA, Moore EE, Moser KS, Brennan R, Read RA, Pons PT. J Trauma. 1995;38:185–193. - PubMed
    1. Bleeding to death in a big city: an analysis of all trauma deaths from hemorrhage in a metropolitan area during 1 year. Kalkwarf KJ, Drake SA, Yang Y, et al. J Trauma Acute Care Surg. 2020;89:716–722. - PubMed
    1. 2020 American Heart Association and American Red Cross focused update for first aid. Pellegrino JL, Charlton NP, Carlson JN, et al. Circulation. 2020;142:0. - PubMed

LinkOut - more resources