Evidence in Support of Tourniquet Use in Major Limb Trauma

Authors: Kragh JF Jr et al., Ann Emerg Med 2015 Mar 65:290

Severely injured soldiers treated with prehospital tourniquets fared as well as those with less severe injuries not treated with tourniquets.

For traumatic limb hemorrhage, tourniquet use is common sense. To quantify its benefit, investigators reviewed data from a registry of injured U.S. soldiers in Afghanistan and Iraq. In an analysis of patients with major limb trauma who reached a hospital alive and received blood transfusion, the investigators compared outcomes between 720 patients who were treated with a tourniquet in the field and 693 who were treated without tourniquets. Tourniquet use was at the discretion of personnel in the field.

The tourniquet group had more severe injuries by multiple measures; for example, they received an average of two units of red cells, versus one unit in the no-tourniquet group. However, despite the difference in injury severity, survival was equivalent in the two groups overall (88% and 89%) and among the subset of patients with only extremity injuries (95% and 94%).
Comment
Of note, this study only examined patients who survived to reach the hospital, so it is likely that some potentially saved lives were probably not counted in this analysis. This retrospective analysis provides indirect evidence in support of common sense: Tourniquets should be used in the field for victims of severe extremity injury with major hemorrhage.