McNickle Allison G, Fraser Douglas R, Chestovich Paul J, Kuhls Deborah A, Fildes John J
Department of Surgery, UNLV School of Medicine, Las Vegas, Nevada, USA.
Surgery, University of Nevada, Las Vegas, Las Vegas, Nevada, USA.
Trauma Surg Acute Care Open. 2019 Jan 24;4(1):e000267. doi: 10.1136/tsaco-2018-000267. eCollection 2019.
Timely tourniquet placement may limit ongoing hemorrhage and reduce the need for blood products. This study evaluates if prehospital tourniquet application altered the initial transfusion needs in arterial injuries when compared with a non-tourniquet control group.
Extremity arterial injuries were queried from our level I trauma center registry from 2013 to 2017. The characteristics of the cohort with prehospital tourniquet placement (TQ+) were described in terms of tourniquet use, duration, and frequency over time. These cases were matched 1:1 by the artery injured, demographics, Injury Severity Score, and mechanism of injury to patients arriving without a tourniquet (TQ-). The primary outcome was transfusion within the first 24 hours, with secondary outcomes of morbidity (rhabdomyolysis, renal failure, compartment syndrome), amputation (initial vs. delayed), and length of stay. Statistical tests included t-test and χ for continuous and categorical variables, respectively, with p<0.05 considered as significant.
Extremity arterial injuries occurred in 192 patients, with 69 (36%) having prehospital tourniquet placement for an average of 78 minutes. Tourniquet use increased over time from 9% (2013) to 62% (2017). TQ+ patients were predominantly male (81%), with a mean age of 35.0 years. Forty-six (67%) received blood transfusion within the first 24 hours. In the matched comparison (n=69 pairs), TQ+ patients had higher initial heart rate (110 vs. 100, p=0.02), frequency of transfusion (67% vs. 48%, p<0.01), and initial amputations (23% vs. 6%, p<0.01). TQ+ patients had increased frequency of initial amputation regardless of upper (n=43 pairs) versus lower (n=26 pairs) extremity involvement; however, only upper extremity TQ+ patients had increased transfusion frequency and volume. No difference was observed in morbidity, length of stay, and mortality with tourniquet use.
Tourniquet use has increased over time in patients with extremity arterial injuries. Patients having prehospital tourniquets required a higher frequency of transfusion and initial amputation, without an increase in complications.
Therapeutic study, level IV.
及时使用止血带可能会限制持续出血，并减少对血液制品的需求。本研究评估与非止血带对照组相比，院前应用止血带是否会改变动脉损伤患者的初始输血需求。
查询了我们一级创伤中心2013年至2017年登记的肢体动脉损伤病例。描述了院前使用止血带（TQ+）队列的止血带使用情况、持续时间和随时间的使用频率。这些病例与未使用止血带到达的患者（TQ-）按受伤动脉、人口统计学、损伤严重程度评分和损伤机制进行1:1匹配。主要结局是24小时内输血情况，次要结局包括发病率（横纹肌溶解、肾衰竭、骨筋膜室综合征）、截肢情况（初始截肢与延迟截肢）和住院时间。统计检验分别包括对连续变量和分类变量的t检验和χ检验，p<0.05被视为具有统计学意义。
192例患者发生肢体动脉损伤，其中69例（36%）院前使用了止血带，平均使用时间为78分钟。止血带的使用随时间从2013年的9%增加到2017年的62%。TQ+组患者以男性为主（81%），平均年龄35.0岁。46例（67%）在24小时内接受了输血。在匹配比较中（n = 69对），TQ+组患者初始心率更高（110对100，p = 0.02）、输血频率更高（67%对48%，p<0.01）和初始截肢率更高（23%对6%，p<0.01）。无论上肢（n = 43对）还是下肢（n = 26对）受累，TQ+组患者初始截肢频率均增加；然而，只有上肢TQ+组患者输血频率和输血量增加。使用止血带在发病率、住院时间和死亡率方面未观察到差异。
随着时间推移，肢体动脉损伤患者使用止血带的情况有所增加。院前使用止血带的患者输血频率和初始截肢率更高，但并发症并未增加。
治疗性研究，IV级。
