评估当前一代止血带。

Assessing the Current Generation of Tourniquets.

机构信息

Faculty of Medicine, Institute for Research in Military Medicine, The Hebrew University of Jerusalem and Israel Defense Forces Medical Corps, POB 12272, Jerusalem 91120, Israel.

Biomedical Engineering Branch, Headquarters of the Surgeon General, Headquarters of the Surgeon General, Military POB 02149 Tel Hashomer, Ramat Gan, Israel, Military Postal Code 01215.

出版信息

Mil Med. 2020 Mar 2;185(3-4):e377-e382. doi: 10.1093/milmed/usz392.

DOI:10.1093/milmed/usz392

PMID:32091602

Abstract

INTRODUCTION

Tourniquet application is an urgent life-saving procedure. Previous studies demonstrated several drawbacks in tourniquet design and application methods that limit their efficacy; among them, loose application of the device before windlass twisting is a main pitfall. A new generation of modern combat tourniquets was developed to overcome these pitfalls. The objective of this study was to assess the effectiveness of three new tourniquet designs: the CAT Generation 7 (CAT7), the SAM Extremity Tourniquet (SAM-XT), and the SOF Tactical Tourniquet Wide (SOFTT-W) as well as its correlation to the degree of slack.

MATERIALS AND METHODS

The three tourniquet models were applied in a randomized sequence on a HapMed leg tourniquet trainer, simulating an above-the-knee traumatic amputation by 60 military medicine track cadets. Applied pressure, hemorrhage control status, time until the bleeding stopped, estimated blood volume loss, and slack were measured.

RESULTS

The mean (±SD) pressure applied using the SAM-XT (186 mmHg ±63) or the CAT7 (175 mmHg ±79) was significantly higher compared to the pressure applied by the SOFTT-W (104 mmHg ±101, P < 0.017), with no significant difference between the first two (P > 0.05). Hemorrhage control rate was similar (P > 0.05) with SAM-XT (73.3%) and CAT7 (67.7%), and both were significantly better than the SOFTT-W (35%, P < 0.017). Slack was similar between CAT7 and SAM-XT (5.2 mm ± 3.4 vs. 5 mm ± 3.5, P > 0.05), yet significantly lower compared to the SOFTT-W (9 mm ± 5, P < 0.017). A strong negative correlation was found between slack and hemorrhage control rate (3.2 mm ± 1.5 mm in success vs. 10.5 mm ± 3.4 mm in failure, P < 0.001) and applied pressure (Pearson's correlation coefficient of -0.83, P < 0.001).

CONCLUSIONS

Both SAM-XT and CAT7 demonstrated a better pressure profile and hemorrhage control rate compared to SOFTT-W, with no significant difference between the two. The better outcome measures were strongly correlated to less slack.

摘要

简介

止血带的应用是一项紧急的救生程序。先前的研究表明，止血带的设计和应用方法存在一些缺陷，限制了其效果；其中，在绞紧绞盘之前，止血带松动的应用是一个主要的陷阱。新一代现代战斗止血带应运而生，以克服这些缺陷。本研究旨在评估三种新型止血带设计的有效性：CAT 第七代（CAT7）、SAM 四肢止血带（SAM-XT）和 SOF 战术止血带宽型（SOFTT-W），以及其与松弛度的相关性。

材料与方法

由 60 名军事医学轨道学员在 HapMed 腿部止血带训练器上随机顺序应用三种止血带模型，模拟膝上创伤性截肢。测量应用压力、出血控制状态、出血停止时间、估计失血量和松弛度。

结果

SAM-XT（186mmHg±63）或 CAT7（175mmHg±79）的平均（±SD）压力明显高于 SOFTT-W（104mmHg±101，P<0.017），而前两者之间无显著差异（P>0.05）。SAM-XT（73.3%）和 CAT7（67.7%）的止血控制率相似（P>0.05），均明显优于 SOFTT-W（35%，P<0.017）。SAM-XT 和 CAT7 之间的松弛度相似（5.2mm±3.4 与 5mm±3.5，P>0.05），但明显低于 SOFTT-W（9mm±5，P<0.017）。松弛度与止血控制率（成功 3.2mm±1.5mm 与失败 10.5mm±3.4mm，P<0.001）和应用压力（Pearson 相关系数 -0.83，P<0.001）呈强负相关。