Background: Uncontrolled bleeding is the leading cause of death in over 30% of trauma patients and is one of the major causes of potentially preventable deaths in both the civilian and military contexts. The plastic surgery department at Christchurch hospital have been involved in three cases of prolonged tourniquet usage in the past 12 months that have resulted in significant patient mortality, prompting a review of the literature surrounding their usage.
Methods: Three separate cases of civilian tourniquet usage and their outcomes are discussed. Both the local and international guidelines on tourniquet application in civilian limb trauma are reviewed. The literature on clinical benefit and complication rates of tourniquet usage in both the military and civilian setting is evaluated.
Results: There are no high-quality randomised control studies assessing the efficacy and safety of emergency limb tourniquet use in civilian setting. Data stems from retrospective reviews based out of urban trauma centres. Recent systematic review and meta-analysis showed no statistical mortality benefit or difference in ICU length of stay. Common complications from tourniquet application that have been reported include nerve palsy, ischaemic reperfusion injury, compartment syndrome, rhabdomyolysis, and thromboembolic events. There are no studies assessing the relationship between tourniquet application time and complications.
Discussion: Majority of the evidence for tourniquet usage has come from the military setting. There are major differences in civilian settings and in mass casualty versus single casualty events. There is likely a difference in results when comparing rural versus urban centres due to proximity to a hospital equipped for treatment. The rate of inappropriate indication for application is reported as high as 21%.
Conclusion: Emergency limb tourniquet usage in civilian trauma can result in significant morbidity. Given the paucity of high-quality research on clinical benefit and complication rates, there is a need for ongoing review and education.