TY - JOUR
T1 - The safety and efficacy of improvised tourniquets in life-threatening hemorrhage: a systematic review
AU - Cornelissen, Maarten Philip
AU - Brandwijk, Anne
AU - Schoonmade, Linda
AU - Giannakopoulos, Georgios
AU - van Oostendorp, Stefan
AU - Geeraedts, Leo
PY - 2020/6/1
Y1 - 2020/6/1
N2 - Objective: The increased incidence of mass casualty incident (MCI) with penetrating injuries in the civilian setting creates a call for implementing devices, such as a tourniquet (TQ), in civilian first aid. Bystanders could act as immediate responders after an MCI in order to prevent a victim from exsanguination using direct pressure or commercial tourniquets (C-TQ). Reports have shown that immediate access to C-TQs was not available and bystanders used objects available at the trauma scene to make an improvised tourniquet (I-TQ). The aim of this systematic review of literature was to summarize the existing literature on designs, efficacy and safety of I-TQs. Methods: A systematic review of the literature was performed. Bibliographic databases PubMed, EMBASE.com and Cochrane Library were searched. All types of original studies about I-TQ’s were included. Review studies, exempts from textbooks or studies with TQs applied during elective surgeries were excluded. Results: Twenty studies were included. In both simulated experiments and real-life situations, I-TQs outperformed commercial TQs (C-TQ) regarding success rate. Of the I-TQs, the band and windlass design performed most consistently. Although lacking any statistical analysis, there was no reported difference in adverse events between I-TQs and C-TQs. Conclusion: The use of- and training in I-TQ by civilian immediate responders is not recommended because of limited efficacy and safety concerns; direct pressure is a viable alternative. However, I-TQs may save lives when applied correctly with proper objects; therefore, future studies regarding the best design and training in application of effective and safe I-TQs should be encouraged.
AB - Objective: The increased incidence of mass casualty incident (MCI) with penetrating injuries in the civilian setting creates a call for implementing devices, such as a tourniquet (TQ), in civilian first aid. Bystanders could act as immediate responders after an MCI in order to prevent a victim from exsanguination using direct pressure or commercial tourniquets (C-TQ). Reports have shown that immediate access to C-TQs was not available and bystanders used objects available at the trauma scene to make an improvised tourniquet (I-TQ). The aim of this systematic review of literature was to summarize the existing literature on designs, efficacy and safety of I-TQs. Methods: A systematic review of the literature was performed. Bibliographic databases PubMed, EMBASE.com and Cochrane Library were searched. All types of original studies about I-TQ’s were included. Review studies, exempts from textbooks or studies with TQs applied during elective surgeries were excluded. Results: Twenty studies were included. In both simulated experiments and real-life situations, I-TQs outperformed commercial TQs (C-TQ) regarding success rate. Of the I-TQs, the band and windlass design performed most consistently. Although lacking any statistical analysis, there was no reported difference in adverse events between I-TQs and C-TQs. Conclusion: The use of- and training in I-TQ by civilian immediate responders is not recommended because of limited efficacy and safety concerns; direct pressure is a viable alternative. However, I-TQs may save lives when applied correctly with proper objects; therefore, future studies regarding the best design and training in application of effective and safe I-TQs should be encouraged.
KW - Bystander
KW - Exsanguination
KW - Hartford consensus
KW - Hemorrhage
KW - Improvised
KW - Tourniquet
UR - http://www.scopus.com/inward/record.url?scp=85071183830&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00068-019-01202-5
DO - https://doi.org/10.1007/s00068-019-01202-5
M3 - Review article
C2 - 31432195
SN - 1863-9933
VL - 46
SP - 531
EP - 538
JO - European journal of trauma and emergency surgery
JF - European journal of trauma and emergency surgery
IS - 3
ER -