Arterial Occlusion Effectiveness of Space Blanket‒Improvised Tourniquets for the Remote Setting

Hannah Salchner; Markus Isser; Lukas Banyai; Thomas Schachner; Franz J Wiedermann; Wolfgang Lederer

doi:10.1016/j.wem.2023.02.007

Arterial Occlusion Effectiveness of Space Blanket‒Improvised Tourniquets for the Remote Setting

Wilderness Environ Med. 2023 Sep;34(3):269-276. doi: 10.1016/j.wem.2023.02.007. Epub 2023 Apr 24.

Authors

Hannah Salchner¹, Markus Isser², Lukas Banyai³, Thomas Schachner⁴, Franz J Wiedermann³, Wolfgang Lederer⁵

Affiliations

¹ Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria; Medical Division, Austrian Mountain Rescue Service-Tyrol, Telfs, Austria.
² Medical Division, Austrian Mountain Rescue Service-Tyrol, Telfs, Austria.
³ Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria.
⁴ Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria.
⁵ Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria. Electronic address: wolfgang.lederer@i-med.ac.at.

PMID: 37100664
DOI: 10.1016/j.wem.2023.02.007

Abstract

Introduction: Control of severe extremity hemorrhage by tourniquet can save lives. In remote areas or in mass casualty incidents with multiple severely bleeding victims, lack of conventional tourniquets may make it necessary to improvise tourniquets.

Methods: Occlusion of the radial artery and delayed onset of capillary refill time resulting from windlass-type tourniquets were experimentally investigated by comparing a commercial tourniquet and a space blanket‒improvised tourniquet with a carabiner as a rod. This observational study was conducted on healthy volunteers in optimal application circumstances.

Results: Operator-applied Combat Application Tourniquets were deployed more swiftly (27 s, 95% CI: 25.7-30.2 vs 94 s, 95% CI: 81.7-114.4) and achieved 100% complete radial occlusion compared with improvised tourniquets, as assessed by Doppler sonography (P<0.001). When space blanket‒improvised tourniquets were used, traces of radial perfusion persisted in 48% of the applications. In Combat Application Tourniquets, capillary refill times were significantly delayed (7 s, 95% CI: 6.0-8.2 vs 5 s, 95% CI: 3.9-6.3) compared with those when using improvised tourniquets (P=0.013).

Conclusions: Improvised tourniquets should be considered only in dire circumstances with uncontrolled extremity hemorrhage and when no commercial tourniquets are available. Complete arterial occlusion was achieved in only half of the applications using a space blanket‒improvised tourniquet when a carabiner was used as a windlass rod. The speed of application was inferior to that for Combat Application Tourniquets. Similar to Combat Action Tourniquets, the correct assembly and application of space blanket‒improvised tourniquets on upper and lower extremities have to be trained.

Trial registration: ClinicalTrials.gov identifier: BASG No.: 13370800/15451670.

Keywords: Stop the Bleed; emergency medical services; hemorrhage control; rescue work; test; tourniquet pain; wilderness medicine.

Publication types

Observational Study

MeSH terms

Arterial Occlusive Diseases*
Equipment Design
Hemorrhage / therapy
Humans
Lower Extremity
Tourniquets*