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


CONCLUSIONS
In order to adequately stop limb hemorrhage, soldiers should be taught their optimal turn degrees.
Department of General Surgery, Gulhane Military Medical Faculty, Ankara, Turkey.
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Ünlü
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. patrizio.petrone@gmail.com.
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Petrone
Department of Radiology, Gulhane Military Medical Faculty, Ankara, Turkey.
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Guvenc
Department of General Surgery, Gulhane Military Medical Faculty, Ankara, Turkey.
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Kaymak
Department of Cadiovascular Surgery, Gulhane Military Medical Faculty, Ankara, Turkey.
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Arslan
Department of Cadiovascular Surgery, Gulhane Military Medical Faculty, Ankara, Turkey.
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Kaya
Department of Blood Bank, Gulhane Military Medical Faculty, Ankara, Turkey.
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Yilmaz
Department of Blood Bank, Gulhane Military Medical Faculty, Ankara, Turkey.
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Cetinkaya
Department of Orthopaedics, Gulhane Military Medical Faculty, Ankara, Turkey.
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Ege
Department of General Surgery, Gulhane Military Medical Faculty, Ankara, Turkey.
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Ozer
Department of Public Health, Gulhane Military Medical Faculty, Ankara, Turkey.
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Kilic
D000328:Adult; D004867:Equipment Design; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply / Q000293:injuries*; D008297:Male; D008889:Military Personnel; D011150:Popliteal Artery / Q000503:physiopathology; D011446:Prospective Studies; D011673:Pulsatile Flow; D014111:Tourniquets; D016896:Treatment Outcome; D014857:Warfare; D014947:Wounds and Injuries / Q000150:complications
CAT; Injury; Lower limb; Tourniquet