Tourniquet use has been proven to reduce mortality on the battlefield. Although empirically transitioned to the civilian environment, data substantiating survival benefit attributable to civilian tourniquet use is lacking. We hypothesized that civilian prehospital tourniquet use is associated with reduced mortality in patients with peripheral vascular injuries.
Multicenter retrospective review of all patients sustaining peripheral vascular injuries admitted to 11 Level I trauma centers (Jan/2011-Dec/2016). The study population was divided into two groups based on prehospital tourniquet use. Baseline characteristics were compared and factors associated with mortality identified. Logistic regression, adjusting for demographic, physiologic and injury-related parameters was used to evaluate the association between prehospital tourniquet use and mortality. Delayed amputation was the secondary outcome.
Over 6 years, 1,026 patients with peripheral vascular injuries were admitted. Prehospital tourniquets were used in 181(17.6%) patients. Tourniquet time averaged 77.3±63.3min (IQR: 39.0-92.3 min). Traumatic amputations occurred in 98 patients (35.7% had a tourniquet). Mortality was 5.2% in the Non-Tourniquet group compared to 3.9% in the Tourniquet group [OR(95%CI):1.36(0.60-1.65), p=0.452]. After multivariable analysis, the use of tourniquets was found to be independently associated with survival [Adjusted OR(95%CI): 5.86(1.41-24.47), Adjusted p=0.015]. Delayed amputation rates were not significantly different between the two groups [1.1% vs. 1.1%, Adjusted OR(95% CI):1.82(0.36-9.99), Adjusted p=0.473].
Although still underutilized, civilian prehospital tourniquet application was independently associated with a six-fold mortality reduction in patients with peripheral vascular injuries. More aggressive prehospital application of extremity tourniquets in civilian trauma patients with extremity hemorrhage and traumatic amputation is warranted.
Civilian Prehospital Tourniquet Use Is Associated with Improved Survival in Patients with Peripheral Vascular Injuries.