Prehospital tourniquet use in operation Iraqi freedom: Effect on hemorrhage control and outcomes
Prehospital tourniquet use in operation Iraqi freedom: Effect on hemorrhage control and outcomes
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DOI：
10.1097/ta.0b013e318160937e
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发表时间：
2008-02-01
影响因子：
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通讯作者：
Holcomb, John B.
中科院分区：
文献类型：
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作者：
Beekley, Alec C.;Sebesta, James A.;Holcomb, John B.
背景：越南战争期间，高达 9% 的阵亡人员因四肢受伤失血过多而死亡。对第二次世界大战期间和以色列国防军使用的院前止血带的回顾性审查显示，当止血带使用时间少于 6 小时时，四肢出血控制有所改善，并且很少出现肢体不良后果。假设：我们假设院前止血带的使用减少了四肢受伤引起的出血并挽救了生命，并且与肢体不良后果的大幅增加无关。方法：这是一项机构审查在伊拉克自由行动期间，委员会批准对第 31 战斗支援医院进行为期一年的回顾性审查。纳入标准是任何患有创伤性截肢、四肢主要血管损伤或有记录的院前止血带的患者。结果：在总共 3,444 名入院患者中，165 名患者符合纳入标准。 67 名患者院前使用了止血带 (TK)； 98名患者四肢严重受伤，但院前未使用止血带（No TK）。两组的肢体急性损伤评分相同（3.5 TK vs. 3.4 无 TK）。手臂损伤患者数量（16.2% TK vs. 30.6% No TK）、需要血管重建的损伤（29.9% TK vs. 52.5% No TK）、创伤性截肢（41.8% TK vs. 26.3% No TK）以及到达时出血得到充分控制的患者数量（83% TK vs. 60% No TK）方面存在差异（p < 0.05）。传统知识）。二次截肢率（4 例（6.0%）TK 与 9 例（9.1%）无 TK）；和死亡率（3 例（4.4%）TK 与 4 例（4.1%）无 TK）没有差异。止血带的使用不被认为是导致四肢严重受损而随后截肢的原因。分析显示，七分之四的死亡可以通过院前功能性止血带放置来预防。结论：院前止血带的使用与出血控制的改善相关，特别是在受伤较严重（损伤严重程度评分> 15）的患者亚组中。百分之五十七的死亡可能可以通过早期使用止血带来避免。没有与使用止血带相关的早期不良后果。
Background: Up to 9% of casualties killed in action during the Vietnam War died from exsanguination from extremity injuries. Retrospective reviews of prehospital tourniquet use in World War II and by the Israeli Defense Forces revealed improvements in extremity hemorrhage control and very few adverse limb outcomes when tourniquet times are less than 6 hours.Hypothesis: We hypothesized that prehospital tourniquet use decreased hemorrhage from extremity injuries and saved lives, and was not associated with a substantial increase in adverse limb outcomes.Methods: This was an institutional review board-approved, retrospective review of the 31st combat support hospital for 1 year during Operation Iraqi Freedom. Inclusion criteria were any patient with a traumatic amputation, major extremity vascular injury, or documented prehospital tourniquet.Results: Among 3,444 total admissions, 165 patients met inclusion criteria. Sixty-seven patients had prehospital tourniquets (TK); 98 patients had severe extremity injuries but no prehospital tourniquet (No TK). Extremity Acute Injury Scores were the same (3.5 TK vs. 3.4 No TK) in both groups. Differences (p < 0.05) were noted in the numbers of patients with arm injuries (16.2% TK vs. 30.6% No TK), injuries requiring vascular reconstruction (29.9% TK vs. 52.5% No TK), traumatic amputations (41.8% TK vs. 26.3% No TK), and in those patients with adequate bleeding control on arrival (83% TK vs. 60% No TK). Secondary amputation rates (4 (6.0%) TK vs. 9 (9.1%) No TK); and mortality (3 (4.4%) TK vs. 4 (4.1%) No TK) did not differ. Tourniquet use was not deemed responsible for subsequent amputation in severely mangled extremities. Analysis revealed that four of seven deaths were potentially preventable with functional prehospital tourniquet placement.Conclusions: Prehospital tourniquet use was associated with improved hemorrhage control, particularly in the worse injured (Injury Severity Score > 15) subset of patients. Fifty-seven percent of the deaths might have been prevented by earlier tourniquet use. There were no early adverse outcomes related to tourniquet use.