• Shane Smith, John White, Kerollos Nashat Wanis, Andrew Beckett, Vivian C McAlister, and Richard Hilsden.
• From the Royal Canadian Medical Service (S.S., J.W., A.B., V.C.M., R.H.), Ottawa; Department of Surgery (S.S., J.W., V.C.M., R.H.), University of Western Ontario, London, ON; Department of Surgery (A.B.), McGill University, Montreal, QC, Canada; and Department of Epidemiology (K.N.W.), Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
• J Trauma Acute Care Surg. 2019 Mar 1; 86 (3): 532-539.

BackgroundJunctional tourniquets have been incorporated into tactical combat casualty care for junctional vascular trauma. They apply external compression to stop blood flow in the groin and axilla.ObjectivesThe primary outcome was effectiveness in achieving arterial occlusion. Secondary outcomes included time to application and pain scores.Data SourcesMedline and EMBASE databases were searched.Study Appraisal And Synthesis MethodsA random-effects meta-analysis was conducted to estimate the average effectiveness and time to effective application for each device.ResultsEight studies reported the effectiveness of junctional tourniquets in healthy volunteers. The average effectiveness was 52% (95% confidence interval [CI], 15-87%) for the abdominal application of the abdominal aortic and junctional tourniquet (AAJT), 83% (95% CI, 73-89%; 26%) for the junctional Emergency Treatment Tool, 87% (95% CI, 79-92%; 15%) for the SAM junctional tourniquet (SJT), and 95% (95% CI, 90-98%) for the Combat Ready Clamp. The groin application of the AAJT was studied in two articles with 100% in both studies. The average time to application was 101 seconds for the SAM junctional tourniquet (95% CI, 50-152 seconds) and the Combat Ready Clamp (95% CI, 63-139 seconds), while it was 130 seconds (95% CI, 85-176 seconds) for the Junctional Emergency Treatment Tool. The abdominal application of AAJT had an average time to application of 92 and 171 seconds in two studies.LimitationsAll studies were conducted in healthy volunteers.Conclusion And ImplicationsJunctional tourniquets may meet a medical need in combat, and in the civilian environment, to control hemorrhage from these difficult injuries. All four Food and Drug Administration-approved devices demonstrate the ability to achieve vascular occlusion in healthy volunteers; however, effectiveness in patient transport has not been evaluated, and outcomes of their use in the field need to be captured and reported.Level Of EvidenceSystematic review, level III.

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