• Teixeira Pedro G R PGR University of Texas at Austin, Dell Medical School, Austin, TX. Electronic address: pgteixeira@austin.utexas.edu., Brown Carlos V R CVR University of Texas at Austin, Dell Medical School, Austin, TX., Brent Emigh, Michael Long, Michael Foreman, Brian Eastridge, Stephen Gale, Michael S Truitt, Sharmila Dissanaike, Therese Duane, John Holcomb, Alex Eastman, Justin Regner, and Texas Tourniquet Study Group.
• University of Texas at Austin, Dell Medical School, Austin, TX. Electronic address: pgteixeira@austin.utexas.edu.
• J. Am. Coll. Surg. 2018 May 1; 226 (5): 769-776.e1.

BackgroundTourniquet use has been proven to reduce mortality on the battlefield. Although empirically transitioned to the civilian environment, data substantiating survival benefit attributable to civilian tourniquet use is lacking. We hypothesized that civilian prehospital tourniquet use is associated with reduced mortality in patients with peripheral vascular injuries.Study DesignWe conducted a multicenter retrospective review of all patients sustaining peripheral vascular injuries admitted to 11 Level I trauma centers (January 2011 through December 2016). The study population was divided into 2 groups based on prehospital tourniquet use. Baseline characteristics were compared and factors associated with mortality identified. Logistic regression, adjusting for demographic, physiologic and injury-related parameters, was used to evaluate the association between prehospital tourniquet use and mortality. Delayed amputation was the secondary end point.ResultsDuring 6 years, 1,026 patients with peripheral vascular injuries were admitted. Prehospital tourniquets were used in 181 (17.6%) patients. Tourniquet time averaged 77.3 ± 63.3 minutes (interquartile range 39.0 to 92.3 minutes). Traumatic amputations occurred in 98 patients (35.7% had a tourniquet). Mortality was 5.2% in the non-tourniquet group compared with 3.9% in the tourniquet group (odds ratio 1.36; 95% CI 0.60 to 1.65; p = 0.452). After multivariable analysis, the use of tourniquets was found to be independently associated with survival (adjusted odds ratio 5.86; 95% CI 1.41 to 24.47; adjusted p = 0.015). Delayed amputation rates were not significantly different between the 2 groups (1.1% vs 1.1%; adjusted odds ratio 1.82; 95% CI 0.36 to 9.99; adjusted p = 0.473).ConclusionsAlthough still underused, civilian prehospital tourniquet application was independently associated with a 6-fold mortality reduction in patients with peripheral vascular injuries. More aggressive prehospital application of extremity tourniquets in civilian trauma patients with extremity hemorrhage and traumatic amputation is warranted.Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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