Although several studies have looked at tourniquet use in civilian settings, the survival benefit for patients was unclear. However, new research from Texas shows that for civilian patients with peripheral vascular injury, prehospital tourniquet use is associated with dramatically improved odds of survival.
The new study — Civilian Prehospital Tourniquet Use Is Associated with Improved Survival in Patients with Peripheral Vascular Injury — was recently published as an article in press by the Journal of the American College of Surgeons.
For the study, the Texas Tourniquet Study Group evaluated 1,026 patients with vascular injuries of the arms or legs admitted to 11 urban Level I trauma centers in Texas from 2011 to 2016. A prehospital tourniquet was used in 17.6 percent of the cases, although tourniquet use varied widely among individual centers, ranging from 62 percent to 1.4 percent.
Average tourniquet time for these patients was about 77 minutes. After multivariable analysis, the non-tourniquet group had almost six times greater odds of death than the group of patients who received a tourniquet (adjusted odds ratio: 5.86).
“This is the first time that we were actually able to prove the survival benefit of using the tourniquet in the civilian population,” said lead study author Pedro Teixeira, MD, FACS, of the University of Texas at Austin, Dell Medical School.
Overall, 9.6 percent of the study patients had amputations, and more than one-third of those patients had received a tourniquet. However, amputation patients who received a tourniquet had significantly lower mortality rates than those who did not — 2.9 percent vs. 7.9 percent.
Tourniquets work best when they are applied as early as possible at the site of the injury, Dr. Teixeira noted. “The ideal person to apply that tourniquet is the person who can do it the quickest immediately after the wound is identified,” he said. “That scenario is the highest chance for the patient to survive.”
(For more information on using tourniquets effectively, read Stop the Bleed: 8 pitfalls to avoid in hemorrhage control.)
While there is a cost involved in having tourniquets available for general use, the Texas Tourniquet Study Group research may help justify that cost, according to an American College of Surgeons press release.
“Being able to demonstrate that tourniquets actually do the job they’re supposed to do is important and supports the recommendations by the Stop the Bleed campaign, contributing to reducing mortality from bleeding on the streets of America and elsewhere,” Dr. Teixeira said.
The study results were first presented in September 2017 at the 76th annual meeting of the American Association for the Surgery of Trauma and Clinical Congress of Acute Care Surgery in Baltimore.