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Written by Michael Stocker
Nearly one quarter of patients receiving prehospital tourniquet application for traumatic injuries experienced in-hospital complications such as local infection and thromboembolism.
Stopping the bleed has risks indeed
Tourniquets are widely used in the prehospital setting to address exsanguinating extremity hemorrhage and are associated with lower transfusion rates and may even reduce fasciotomy rates. Understanding the downstream complications of tourniquet application could help clinicians anticipate the care needs of these patients in the hospital. While complications from prolonged tourniquet application, such as ischemia-reperfusion injuries and compartment syndrome requiring fasciotomy, are well described, in-hospital complications following prehospital tourniquet applications have not been thoroughly studied. This retrospective observational study aimed to identify in-hospital complications arising from prehospital tourniquet applications and to identify risk factors. Adult trauma patients hospitalized at a level 1 trauma center following prehospital tourniquet application over a 10-year period were included (N=84). Over 23% had identified complications, with local infection (55%) being by far the most common, followed by compartment syndrome and local or systemic thromboembolism. Fall as the mechanism of injury and hospital length of stay were found to be significantly associated with increased risk of complications. Notably, all patients in the complications group had grossly contaminated injuries. Limited by its retrospective design and small cohort, this study also lacked a control group of similar patients without tourniquet application, making it difficult to determine if complications could be solely attributed to the tourniquet in light of wound contamination and surgical interventions.
How does this change my practice?
In my prehospital practice, I will continue to carefully assess injuries to determine the need for a tourniquet in order to limit unnecessary applications and avoid complications. That said, the dire implications of withholding or delaying tourniquet application from a patient with potentially life-threatening extremity hemorrhage still outweighs the risks of downstream complications in my mind. Better to treat an infection later than to bleed out now.
Source
The cost of saving lives: Complications arising from prehospital tourniquet application. Acad Emerg Med. 2024 Dec 16. doi: 10.1111/acem.15070. Epub ahead of print. PMID: 39686666
