Department of anesthesiology and intensive care, Begin military teaching hospital, Saint-Mande, France; French Military Medical Service Academy, école du Val-de-Grâce, 75006 Paris, France.
SAMU de Paris, Department of anaesthesia and intensive care, hôpital Necker-Enfants-Malades, université Paris-Descartes-Paris-5, Assistance publique-Hôpitaux de Paris, 75015 Paris, France.
Anaesth Crit Care Pain Med. 2018 Dec;37(6):597-606. doi: 10.1016/j.accpm.2017.11.017. Epub 2018 Jan 5.
The effectiveness of a tourniquet (TQ) in case of extremity haemorrhages is well recognised to prevent deaths on the battlefield. However, little is known about the usefulness of TQ in civilian trauma settings, including terrorist attack situations. The aim of this systematic review was to analyse the evidence-based medical literature in order to precise the use of TQ in the management of extremity haemorrhages in civilian setting.
Analysis of all studies published until 12/31/2016 on the Embase, Medline and Opengrey databases. To be included, studies had to contain descriptions, discussions or experiences of TQ application in civilian setting. The quality of the studies was evaluated using the PRISMA and the STROBE criteria.
Of the 380 studies identified, 24 were included. The overall level of evidence was low. Three thousand and twenty eight TQ placements were reported. Most of them concerned the Combat Application Tourniquet CAT. Haemorrhages implied in the use of TQ were almost exclusively traumatic, most of the time regarding young men (27-44 years old). Effectiveness rates of TQ varied between 78% and 100%. Complications rates associated with the use of TQ remained low, even when used in elderlies or patients with comorbidities. Finally, caregivers reported a common fear of adverse effects, while reported complications were rare (<2%).
This systematic review revealed TQ to be an effective tool for the management of extremity haemorrhages in civilian trauma, associated with few complications. Larger studies and dedicated training courses are needed to improve the use of TQ in the civilian standards of care.
止血带（TQ）在四肢出血中的有效性已被充分证实，可防止战场上的死亡。然而，关于止血带在民用创伤环境中的实用性，包括在恐怖袭击情况下的实用性，人们知之甚少。本系统评价的目的是分析循证医学文献，以明确止血带在民用环境中管理四肢出血的用途。
分析截至 2016 年 12 月 31 日在 Embase、Medline 和 Opengrey 数据库上发表的所有研究。纳入的研究必须包含在民用环境中应用止血带的描述、讨论或经验。使用 PRISMA 和 STROBE 标准评估研究的质量。
在 380 项研究中，有 24 项被纳入。总体证据水平较低。报告了 3028 次止血带放置。其中大多数涉及战斗应用止血带（CAT）。使用止血带导致的出血几乎完全是创伤性的，大多数情况下涉及年轻男性（27-44 岁）。止血带的有效率在 78%到 100%之间变化。与使用止血带相关的并发症率仍然较低，即使在老年人或合并症患者中使用也是如此。最后，护理人员普遍担心会出现不良反应，而报告的并发症很少见（<2%）。
本系统评价显示，止血带是民用创伤中管理四肢出血的有效工具，并发症较少。需要进行更大规模的研究和专门的培训课程，以提高民用护理标准中止血带的使用。
