• Charlotte Beaucreux, Benoît Vivien, Ethan Miles, Sylvain Ausset, and Pierre Pasquier.
• Department of anesthesiology and intensive care, Begin military teaching hospital, Saint-Mande, France; French Military Medical Service Academy, école du Val-de-Grâce, 75006 Paris, France. Electronic address: chbeaucreux@hotmail.fr.
• Anaesth Crit Care Pain Med. 2018 Dec 1; 37 (6): 597-606.

IntroductionThe effectiveness of a tourniquet (TQ) in case of extremity haemorrhages is well recognised to prevent deaths on the battlefield. However, little is known about the usefulness of TQ in civilian trauma settings, including terrorist attack situations. The aim of this systematic review was to analyse the evidence-based medical literature in order to precise the use of TQ in the management of extremity haemorrhages in civilian setting.MethodsAnalysis of all studies published until 12/31/2016 on the Embase, Medline and Opengrey databases. To be included, studies had to contain descriptions, discussions or experiences of TQ application in civilian setting. The quality of the studies was evaluated using the PRISMA and the STROBE criteria.ResultsOf the 380 studies identified, 24 were included. The overall level of evidence was low. Three thousand and twenty eight TQ placements were reported. Most of them concerned the Combat Application Tourniquet CAT. Haemorrhages implied in the use of TQ were almost exclusively traumatic, most of the time regarding young men (27-44 years old). Effectiveness rates of TQ varied between 78% and 100%. Complications rates associated with the use of TQ remained low, even when used in elderlies or patients with comorbidities. Finally, caregivers reported a common fear of adverse effects, while reported complications were rare (<2%).ConclusionThis systematic review revealed TQ to be an effective tool for the management of extremity haemorrhages in civilian trauma, associated with few complications. Larger studies and dedicated training courses are needed to improve the use of TQ in the civilian standards of care.Copyright © 2018 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

19 keywords...

hide…