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The safety and efficacy of improvised tourniquets in life-threatening hemorrhage: a systematic review

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

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.

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Authors and Affiliations

  1. Department of Surgery, Section Trauma Surgery, Amsterdam University Medical Centers, Location VUmc Amsterdam, De Boelelaan, 1117, 1081 HV, Amsterdam, The Netherlands

    Maarten Philip Cornelissen, Anne Brandwijk, Georgios Giannakopoulos, Stefan van Oostendorp & Leo Geeraedts Jr

  2. Medical Library, VU University, Amsterdam, The Netherlands

    Linda Schoonmade

Authors
  1. Maarten Philip Cornelissen
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  2. Anne Brandwijk
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  3. Linda Schoonmade
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  4. Georgios Giannakopoulos
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  5. Stefan van Oostendorp
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Correspondence to Maarten Philip Cornelissen.

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Cornelissen, M.P., Brandwijk, A., Schoonmade, L. et al. The safety and efficacy of improvised tourniquets in life-threatening hemorrhage: a systematic review. Eur J Trauma Emerg Surg 46, 531–538 (2020). https://doi.org/10.1007/s00068-019-01202-5

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  • DOI: https://doi.org/10.1007/s00068-019-01202-5

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