• Aaron Cunningham, Marc Auerbach, Mark Cicero, and Mubeen Jafri.
• From the Department of Surgery (A.C.), Oregon Health and Science University, Portland, Oregon; Department of Emergency Medicine (M.A., M.C.), Yale New Haven Children's Hospital, New Haven, Connecticut; and Division of Pediatric Surgery (M.J.), Doernbecher Children's Hospital, Oregon Health and Science University, Randall Children's Hospital at Legacy Emanuel, Portland, Oregon.
• J Trauma Acute Care Surg. 2018 Oct 1; 85 (4): 665-667.

BackgroundRecent mass casualty events in the United States have highlighted the need for public preparedness to prevent death from uncontrolled hemorrhage. The Pediatric Trauma Society (PTS) reviewed the literature regarding pediatric tourniquet usage with the aim to provide recommendations about the utility of this adjunct for hemorrhage control in children.MethodsSearch terms "pediatric" and "tourniquet" were used to query the US National Library of Medicine National Institutes of Health for pertinent literature. Exclusion criteria include not involving children, not involving the use of an extremity tourniquet, primary outcomes not related to hemorrhage control, tourniquet use to prevent snake envenomation, single case reports, and only foreign language formats available. Bibliographies of remaining studies reviewed to identify additional pertinent research. Four physician members of the PTS Guidelines Committee reviewed identified studies.ResultsOne hundred thirty-four studies were identified. One hundred twenty-three studies were excluded. Seven additional studies were identified through bibliography review. Eighteen pertinent studies were reviewed. Seven articles evaluated physiologic response to tourniquet use in operating room settings. Six articles were generated from combat experience in conflicts in Afghanistan and Iraq. Four articles discussed technical details of tourniquet usage. One article evaluated the use of tourniquets during the Boston Marathon bombing in 2015.ConclusionDespite limited data of limited quality regarding their use, the PTS supports the usage of tourniquets in the prehospital setting and during the resuscitation of children suffering from exsanguinating hemorrhage from severe extremity trauma. Expedited, definitive care must be sought, and tourniquet pressure and time should be limited to the least amount possible. The Society supports the ACS "Stop the Bleed" campaign and encourages further investigation of tourniquet use in children.Level Of EvidenceGuidelines/algorithm study, level IIIa.

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