Limb Complications following Pre-Hospital Tourniquet Use

• Published in: BMJ military health Vol. 155; no. 3; pp. 200 - 202
• Main Authors: Clasper, J, Brown, KV, Hill, P
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.09.2009
• Subjects: Adult; Afghan Campaign 2001; Afghanistan; Arm Injuries - therapy; Case-Control Studies; Cohort Studies; Emergency Medical Services; Humans; Injury Severity Score; Iraq; Iraq War, 2003-2011; Ischemia - etiology; Ischemia - prevention & control; Leg Injuries - therapy; Male; Military Personnel; Retrospective Studies; Tourniquets - adverse effects; United Kingdom; Wounds, Penetrating - therapy; Young Adult
• ISSN: 0035-8665; 2633-3767; 2052-0468; 2633-3775
• DOI: 10.1136/jramc-155-03-06

It has been stated that the application of a pre-hospital tourniquet could prevent 7% of combat deaths, however their widespread use has been questioned due to the potential risk from prolonged ischaemia. We reviewed members of the UK Armed Forces who sustained severe limb-threatening injuries in Iraq and Afghanistan, and performed a matched cohort study based on the presence or absence of pre-hospital tourniquet application. When a pre-hospital tourniquet had been applied, 19/22 patients had a least one complication compared to 15/22 where no tourniquet had been applied [p=0.13]. There were 10 limbs with at least one major complication in the pre-hospital tourniquet group but only four in the group with no tourniquet [p=0.045]. The significant difference in the incidence of major complications is a concern, particularly as the difference was mainly due to a deep infection rate of 32% vs. 4.5%. Although a number of variables could have influenced these small groups, such as choice of fracture fixation implant and method and timing of wound closure, the use of a matched cohort study design with a statistical significance level of p < 0.05, suggests the use of a pre-hospital tourniquet as a factor. Althoughthe use of pre-hospital tourniquets cannot be decried as a result of this study, the need to continually prospectively review their use to determine their risk/benefit ratio remains.