Beaven Alastair, Briard Rob, Ballard Mark, Parker Paul
Royal Centre for Defence Medicine, Queen Elizabeth Hospital, University Hospitals Birmingham Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham, United Kingdom B15 2WB.
Mil Med. 2017 Jul;182(7):e1929-e1932. doi: 10.7205/MILMED-D-16-00298.
Limb tourniquets have been used extensively during modern Middle Eastern conflicts. Despite its undeniable successes, the combat applied tourniquet (C-A-T) has some shortfalls, principally its inability to reliably control lower limb bleeding when applied to the mid-thigh. We tested two tourniquets which may represent an improvement to the combat applied tourniquet; the tactical mechanical tourniquet and the tactical pneumatic tourniquet.
We recruited 12 healthy service personnel and applied the tactical mechanical tourniquet and tactical pneumatic tourniquet to both lower limbs in a randomly generated sequence. Tourniquets were tightened until popliteal artery occlusion. This was measured via a SonoSite portable ultrasound machine by a single consultant vascular radiologist familiar with its use. A longitudinal view of the popliteal artery was obtained, and Doppler waveform monitored. The tourniquets were tightened around volunteers' mid-thigh by a second researcher accustomed with their use. Time to complete occlusion, number of windlass revolutions, and pain scores were collected by a third researcher. Non-normally distributed data are present as median (interquartile range). Ordinal nonparametric data are analysed by Mann-Whitney U testing.
Participants had a median age of 32.5 (28-35). Both tourniquets demonstrated complete occlusion of the popliteal artery in all limbs (n = 24). The mechanical tourniquet achieved arterial occlusion after a median of 3.8 (3-4) turns, and 16 (12-20) seconds. No participants dropped out of the study because of intolerable pain, or any cause. Median pain scores for the mechanical tourniquets were 4.5 (3-7) (maximum pain) and 4.0 (2-7) (pain when locked). Median pain scores for the pneumatic tourniquet were 5 (2-6) (maximum pain) and 5 (2-6) (pain when fully applied). There was no statistical difference in maximum pain scores between the tactical mechanical tourniquet and the tactical pneumatic tourniquet (p = 0.75). No participant had any tourniquet applied for longer than 80 seconds.
Both tourniquets completely occluded the popliteal artery in all participants within an acceptable pain threshold. Further testing is required before the presented tourniquets can be taken to the battlefield; particularly measures of self-application, and use on other anatomical areas.
在现代中东冲突中，肢体止血带得到了广泛应用。尽管战斗应用止血带（C-A-T）取得了不可否认的成功，但它也存在一些不足，主要是应用于大腿中部时无法可靠地控制下肢出血。我们测试了两种可能对战斗应用止血带有所改进的止血带：战术机械止血带和战术气动止血带。
我们招募了12名健康的服务人员，并以随机生成的顺序将战术机械止血带和战术气动止血带应用于双下肢。将止血带收紧直至腘动脉闭塞。由一位熟悉其使用方法的血管放射科顾问使用SonoSite便携式超声机进行测量。获取腘动脉的纵向视图，并监测多普勒波形。由另一位熟悉其使用方法的研究人员在志愿者大腿中部收紧止血带。由第三位研究人员收集完成闭塞的时间、绞盘转动次数和疼痛评分。非正态分布数据以中位数（四分位间距）表示。有序非参数数据通过曼-惠特尼U检验进行分析。
参与者的年龄中位数为32.5岁（28 - 35岁）。两种止血带在所有肢体（n = 24）中均显示腘动脉完全闭塞。机械止血带在中位数为3.8（3 - 4）圈和16（12 - 20）秒后实现动脉闭塞。没有参与者因无法忍受的疼痛或任何原因退出研究。机械止血带的最大疼痛中位数评分是4.5（3 - 7）（最大疼痛）和4.0（2 - 7）（锁定时疼痛）。气动止血带的最大疼痛中位数评分是5（2 - 6）（最大疼痛）和5（2 - 6）（完全应用时疼痛）。战术机械止血带和战术气动止血带的最大疼痛评分之间无统计学差异（p = 0.75）。没有参与者使用止血带的时间超过80秒。
两种止血带在可接受的疼痛阈值内使所有参与者的腘动脉完全闭塞。在将所展示的止血带用于战场之前，还需要进一步测试；特别是自我应用的措施以及在其他解剖部位的使用。
