Skip to main content

Advertisement

SpringerLink
Log in

Combat application tourniquet (CAT) eradicates popliteal pulses effectively by correcting the windlass turn degrees: a trial on 145 participants

  • Original Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Introduction

We aimed to define an ideal range of windlass turn degrees for 100 % success rates within the study population.

Methods

CAT was applied at mid-thigh level. Data included age, lower extremity circumference (LEC), body mass index (BMI), and mean arterial pressure (MAP). Windlass turn degrees were measured in failed and successful participants. The failed participants’ windlass mechanisms were twisted until the popliteal artery was occluded. Failure to success and additional turn degrees to secure the windlass mechanism of CAT was determined. Doppler ultrasound was used to examine the popliteal artery blood flow.

Results

145 servicemen have participated in the study. Initially, 70 % successfully applied CAT. There was no statistically significant difference in BMI and MAP values between successful and failed participants. The mean LEC for failed and successful applications were 57.5 ± 4 and 56.8 ± 4, respectively. The required turn degrees for success ranged between 45° and 270°. After correction, the cumulative success rate of 93 and 100 % was reached at 990° and 1170° overall turn degrees.

Discussion

In order to adequately stop limb hemorrhage, soldiers should be taught their optimal turn degrees.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price includes VAT (Austria)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Murray CK, Obremsky WT, Hsu JR, Andersen RC, Calhoun JH, Clasper JC, Whitman TJ, Curry TK, Fleming ME, Wenke JC, Ficke JR. Prevention of infections associated with combat-related extremity injuries. J Trauma. 2011;71(2):S235–57.

    Article  CAS  PubMed  Google Scholar 

  2. Lakstein D, Blumenfeld A, Sokolov T, Lin G, Bssorai R, Lynn M, Ben-Abraham R. Tourniquets for hemorrhage control on the battle field: a 4-year accumulated experience. J Trauma. 2003;54:S221–5.

    PubMed  Google Scholar 

  3. Alam HB, Rhee R. New developments in fluid resuscitation. Surg Clin N Am. 2007;87:55–72.

    Article  PubMed  Google Scholar 

  4. Lee C, Porter KM, Hodgetts TJ. Tourniquet use in the prehospital civilian setting. Emerg Med J. 2007;24(8):584–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Dorlac WC, Debakey ME, Holcomb JB, Fagan SP, Kwong KL, Dorlac GR, Schreiber MA, Persse DE, Moore FA, Mattox KL. Mortality from isolated civilian penetrating extremity injury. J Trauma. 2005;59(1):217–22.

    Article  CAS  PubMed  Google Scholar 

  6. King RB, Filips D, Blitz S, Logsetty S. Evaluation of possible tourniquet systems for use in the Canadian forces. J Trauma. 2006;60:1061–71.

    Article  PubMed  Google Scholar 

  7. Kragh JF, O’Neill ML, Walters TJ, Dubick MA, Baer DG, Wade CE, Holcomb JB, Blackbourne LH. The Military Emergency Tourniquet Program’s lessons learned with devices and designs. Mil Med. 2011;176(10):1144–52.

    Article  PubMed  Google Scholar 

  8. Taylor DM, Vater GM, Parker PJ. An evaluation of two tourniquet systems for the control of prehospital lower limb hemorrhage. J Trauma. 2011;71:591–5.

    Article  PubMed  Google Scholar 

  9. Kragh JF, Walters TJ, Baer DG, Fox CJ, Wade CE, Salinas J, Holcomb JB. Practical use of emergency tourniquets to stop bleeding in major limb trauma. J Trauma. 2008;64(2):38–49.

    Article  Google Scholar 

  10. Walters TJ, Wenke JC, Kauvar DS, McManus JG, Holcomb JB, Baer DG. Effectiveness of self applied tourniquets in human volunteers. Prehosp Emerg Care. 2005;9:416–22.

    Article  PubMed  Google Scholar 

  11. Unlu A, Kaya E, Guvenc I, Kaymak S, Cetinkaya RA, Lapsekili EO, Ozer MT, Guler A, Yildiz R, Petrone P, Harlak A, Kilic S. An evaluation of combat application tourniquets on training military personnel: changes in application times and success rates in three successive phases. J R Army Med Corps. 2014;. doi:10.1136/jramc-2014-000339.

    PubMed  Google Scholar 

  12. Holcomb JB, McMullin NR, Pearse L, Caruso J, Wade CE, Oetjen-Gerdes L, Champion HR, Lawnick M, Farr W, Rodriguez S, Butler FK. Causes of death in U.S. Special Operations Forces in the global war on terrorism: 2001–2004. Ann Surg. 2007;245:986–91.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Beekley AC, Sebesta JA, Blackbourne LH, Herbert GS, Kauvar DS, Baer DG, Walters TJ, Mullenix PS, Holcomb JB. Prehospital tourniquet use in operation Iraqi Freedom: effect on hemorrhage control and outcomes. J Trauma. 2008;64:S28–37.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General Surgery, Gulhane Military Medical Faculty, Ankara, Turkey

    A. Ünlü, S. Kaymak & M. T. Ozer

  2. Division of Trauma Surgery, Critical Care and Acute Care Surgery, Department of Surgery, New York Medical College, Westchester Medical Center University Hospital, Valhalla, NY, USA

    P. Petrone

  3. Department of Radiology, Gulhane Military Medical Faculty, Ankara, Turkey

    I. Guvenc

  4. Department of Cadiovascular Surgery, Gulhane Military Medical Faculty, Ankara, Turkey

    G. Arslan & E. Kaya

  5. Department of Blood Bank, Gulhane Military Medical Faculty, Ankara, Turkey

    S. Yilmaz & R. A. Cetinkaya

  6. Department of Orthopaedics, Gulhane Military Medical Faculty, Ankara, Turkey

    T. Ege

  7. Department of Public Health, Gulhane Military Medical Faculty, Ankara, Turkey

    S. Kilic

Authors
  1. A. Ünlü
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Petrone
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. I. Guvenc
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Kaymak
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. Arslan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. E. Kaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. S. Yilmaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. R. A. Cetinkaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. T. Ege
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. M. T. Ozer
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. S. Kilic
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P. Petrone.

Ethics declarations

Conflict of interest

Aytekin Ünlü, Patrizio Petrone, Inanc Guvenc, Sahin Kaymak, Gokhan Arslan, Erkan Kaya, Soner Yilmaz, R. Aytac Cetinkaya, Tolga Ege, M. Tahir Ozer, and Selim Kilic declare that they have no conflict of interest.

Ethical approval

The study was designed as a prospective, randomized trial, and approved by Gulhane Military Medical Academy Research Ethics Committee.

Informed consent

The prospective participants received a complete explanation sheet for the aim, risks, and details of the study. Written consent was obtained from each participant.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ünlü, A., Petrone, P., Guvenc, I. et al. Combat application tourniquet (CAT) eradicates popliteal pulses effectively by correcting the windlass turn degrees: a trial on 145 participants. Eur J Trauma Emerg Surg 43, 605–609 (2017). https://doi.org/10.1007/s00068-015-0582-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00068-015-0582-0

Keywords

Search

Navigation