title: Tourniquet use for peripheral vascular injuries in the civilian setting.
abstract: BACKGROUND
  Haemorrhage in peripheral vascular injuries may cause life-threatening exsanguination. Tourniquets are used extensively by the military, with increased interest in the civilian setting to prevent deaths. This is a retrospective study of trauma patients at two large Canadian trauma centres with arterial injury after isolated extremity trauma. We hypothesized that tourniquet use may decrease mortality rate and transfusion requirements if applied early.
  
  
  METHODS
  The study group was all adult patients at two Level 1 Trauma Centres in two Canadian cities in Canada, who had arterial injuries from extremity trauma. The study period was from January 2001 to December 2010. We excluded patients with significant associated injuries. The intervention in this study was prehospital tourniquet use. The main outcome was in-hospital mortality. Secondary outcomes were length of stay, compartment syndrome, amputation, and blood product transfusion.
  
  
  RESULTS
  190 patients were included in the study, and only 4 patients had a prehospital tourniquet applied. They arrived directly from the scene of injury, had improvised tourniquets by police or bystanders, and showed a trend to be more hypotensive and acidotic. Four other patients had tourniquets applied in the trauma bay within 1h of injury. There were no differences in age, sex, injury severity or physiologic presentation between patients who had an early tourniquet applied and those who died without a tourniquet. However, six patients died without a tourniquet, and all bled to death. Of the eight patients who had early tourniquets applied, none died.
  
  
  CONCLUSIONS
  Tourniquets may prevent exsanguination in the civilian setting for patients suffering either blunt or penetrating trauma to the extremity. Future studies will help determine the utility of deploying tourniquets in the civilian setting, given the rarity of exsanguinating haemorrhage from isolated extremity trauma in this setting.
authors.affiliation: McMaster University, Department of Surgery, Canada.
authors.forename: Edward
authors.initials: E
authors.lastname: Passos
authors.affiliation: University of Calgary, Department of Surgery, Canada.
authors.forename: Brittany
authors.initials: B
authors.lastname: Dingley
authors.affiliation: University of Calgary, Department of Surgery, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Smith
authors.affiliation: University of Alberta, Department of Surgery, Canada.
authors.forename: Paul T
authors.initials: PT
authors.lastname: Engels
authors.affiliation: University of Calgary, Department of Surgery, Canada.
authors.forename: Chad G
authors.initials: CG
authors.lastname: Ball
authors.affiliation: McMaster University, Department of Surgery, Canada.
authors.forename: Samir
authors.initials: S
authors.lastname: Faidi
authors.affiliation: University of Toronto, Department of Surgery, Sunnybrook Health Sciences Centre, Canada.
authors.forename: Avery
authors.initials: A
authors.lastname: Nathens
authors.affiliation: University of Toronto, Department of Surgery, Sunnybrook Health Sciences Centre, Canada. Electronic address: homer.tien@sunnybrook.ca.
authors.forename: Homer
authors.initials: H
authors.lastname: Tien
mesh_terms: D000328:Adult; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002170:Canada; D004632:Emergency Medical Services / Q000379:methods; D058734:Exsanguination / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D005121:Extremities / Q000293:injuries; D005260:Female; D006470:Hemorrhage / Q000401:mortality / Q000517:prevention & control*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014111:Tourniquets; D014193:Trauma Centers; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000150:complications / Q000401:mortality / Q000628:therapy*; D014947:Wounds and Injuries / Q000150:complications / Q000401:mortality / Q000628:therapy*
keywords: Haemorrhage; Peripheral vascular injury; Tourniquets; Trauma