AAST multicenter prospective analysis of prehospital tourniquet use for extremity trauma

Rebecca Schroll; Alison Smith; Kelsey Alabaster; Thomas J Schroeppel; Zachery E Stillman; Erik J Teicher; Elena Lita; Paula Ferrada; Jinfeng Han; Robert D Fullerton; Allison G McNickle; Douglas R Fraser; Michael S Truitt; Heather M Grossman Verner; S Rob Todd; David Turay; Andrew Pop; Laura N Godat; Todd W Costantini; Desmond Khor; Kenji Inaba; James Bardes; Alison Wilson; John G Myers; James M Haan; Kelly L Lightwine; Henrik O Berdel; Anthony J Bottiggi; Warren Dorlac; Linda Zier; Grace Chang; Mae Lindner; Benjamin Martinez; Danielle Tatum; Peter E Fischer; Mark Lieser; Robert C Mabe; Lawrence Lottenberg; Catherine G Velopoulos; Shane Urban; Marquinn Duke; Amy Brown; Merry Peckham; AlleaBelle Gongola; Toby M Enniss; Pedro Teixeira; Dennis Y Kim; George Singer; Peter Ekeh; Claire Hardman; Reza Askari; Barbara Okafor; Juan Duchesne

doi:10.1097/TA.0000000000003555

AAST multicenter prospective analysis of prehospital tourniquet use for extremity trauma

J Trauma Acute Care Surg. 2022 Jun 1;92(6):997-1004. doi: 10.1097/TA.0000000000003555. Epub 2022 Jan 18.

Authors

Rebecca Schroll¹, Alison Smith, Kelsey Alabaster, Thomas J Schroeppel, Zachery E Stillman, Erik J Teicher, Elena Lita, Paula Ferrada, Jinfeng Han, Robert D Fullerton, Allison G McNickle, Douglas R Fraser, Michael S Truitt, Heather M Grossman Verner, S Rob Todd, David Turay, Andrew Pop, Laura N Godat, Todd W Costantini, Desmond Khor, Kenji Inaba, James Bardes, Alison Wilson, John G Myers, James M Haan, Kelly L Lightwine, Henrik O Berdel, Anthony J Bottiggi, Warren Dorlac, Linda Zier, Grace Chang, Mae Lindner, Benjamin Martinez, Danielle Tatum, Peter E Fischer, Mark Lieser, Robert C Mabe, Lawrence Lottenberg, Catherine G Velopoulos, Shane Urban, Marquinn Duke, Amy Brown, Merry Peckham, AlleaBelle Gongola, Toby M Enniss, Pedro Teixeira, Dennis Y Kim, George Singer, Peter Ekeh, Claire Hardman, Reza Askari, Barbara Okafor, Juan Duchesne

Affiliation

¹ From the Department of Surgery (R.S., A.S., K.A., J.D.), Tulane University School of Medicine, New Orleans, Louisiana; University of Colorado Health Memorial (T.J.S., Z.E.S.), Colorado Springs, Colorado; Inova Trauma Center (E.J.T., E.L.), Inova Fairfax Hospital, Annandale; Department of Surgery (P.F., J.H.), Virginia Commonwealth University, Richmond, Virginia; Department of Surgery (R.D.F.), Cooper University Health Care, Camden, New Jersey; Acute Care Surgery Division (A.G.M., D.R.F.), University of Nevada, Las Vegas, Las Vegas, Nevada; Department of Surgery (M.S.T., H.M.G.V.), Methodist Dallas Medical Center, Dallas, Texas; Department of Surgery (S.R.T.), Baylor College of Medicine, Houston, Texas; Department of Surgery (D.Tu., A.P.), Loma Linda University Medical Center, Loma Linda; Department of Surgery (L.N.G., T.W.C.), University of California San Diego; Department of Surgery (D.K., K.I.), Los Angeles County, University of Southern California Medical Center, Los Angeles, California; Department of Surgery (J.B., A.W.), West Virginia University, Morgantown, West Virginia; Department of Surgery (J.G.M.), University of Texas Health Science Center at San Antonio, San Antonio, Texas; Department of Trauma Services (J.M.H., K.L.L.), Ascension Via Christi Saint Francis, Wichita, Kansas; Department of Surgery (H.O.B., A.J.B.), University of Kentucky, Lexington, Kentucky; Department of Trauma and Acute Care (W.D., L.Z.), Medical Center of the Rockies, Loveland, Colorado; Department of Surgery (G.C., M.Lin.), Mount Sinai Hospital, New York, New York; Department of Surgery (B.M., D.Ta.), Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana; Department of Surgery (P.E.F.), The University of Tennessee Health Science Center; Elvis Presley Trauma Center (M.Lie.), Regional One Health, Memphis, Tennessee; Research Medical Center (R.C.M.), EmCare Surgical Services, Kansas City, Missouri; Department of Trauma Research and Education (L.L.), St. Mary's Medical Center, West Palm Beach, Florida; Department of Surgery (C.G.V., S.U.), University of Colorado Hospital, Aurora, Colorado; Trauma Department (M.D., A.B.), North Oaks Medical Center, Hammond, Louisiana; Department of Surgery (M.P., A.G.), University of Arkansas Medical Center, Little Rock, Arkansas; Department of Surgery (T.M.E.), University of Utah, Salt Lake City, Utah; Department of Surgery (P.T.), University of Texas at Austin, Austin, Texas; Department of Surgery (D.Y.K., G.S.), Harbor-UCLA Medical Center, West Carson, California; Department of Surgery (P.E., C.H.), Wright State University, Dayton, Ohio; and Department of Surgery (R.A., B.O.), Brigham and Women's Hospital, Boston, Massachusetts.

PMID: 35609289
DOI: 10.1097/TA.0000000000003555

Abstract

Background: Tourniquet use for extremity hemorrhage control has seen a recent increase in civilian usage. Previous retrospective studies demonstrated that tourniquets improve outcomes for major extremity trauma (MET). No prospective study has been conducted to date. The objective of this study was to evaluate outcomes in MET patients with prehospital tourniquet use. We hypothesized that prehospital tourniquet use in MET decreases the incidence of patients arriving to the trauma center in shock.

Methods: Data were collected prospectively for adult patients with MET at 26 Level I and 3 Level II trauma centers from 2015 to 2020. Limbs with tourniquets applied in the prehospital setting were included in the tourniquet group and limbs without prehospital tourniquets were enrolled in the control group.

Results: A total of 1,392 injured limbs were enrolled with 1,130 tourniquets, including 962 prehospital tourniquets. The control group consisted of 262 limbs without prehospital tourniquets and 88 with tourniquets placed upon hospital arrival. Prehospital improvised tourniquets were placed in 42 patients. Tourniquets effectively controlled bleeding in 87.7% of limbs. Tourniquet and control groups were similarly matched for demographics, Injury Severity Score, and prehospital vital signs (p > 0.05). Despite higher limb injury severity, patients in the tourniquet group were less likely to arrive in shock compared with the control group (13.0% vs. 17.4%, p = 0.04). The incidence of limb complications was not significantly higher in the tourniquet group (p > 0.05).

Conclusion: This study is the first prospective analysis of prehospital tourniquet use for civilian extremity trauma. Prehospital tourniquet application was associated with decreased incidence of arrival in shock without increasing limb complications. We found widespread tourniquet use, high effectiveness, and a low number of improvised tourniquets. This study provides further evidence that tourniquets are being widely and safely adopted to improve outcomes in civilians with MET.

Level of evidence: Therapeutic/Care Management; Level IV.

Publication types

Multicenter Study

MeSH terms

Adult
Emergency Medical Services*
Extremities / injuries*
Hemorrhage / etiology
Hemorrhage / prevention & control*
Hemorrhage / therapy
Humans
Prospective Studies
Retrospective Studies
Shock / prevention & control
Tourniquets* / adverse effects
Trauma Centers
Wounds and Injuries / complications