Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
Section of Emergency Medicine, Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan.
World J Emerg Surg. 2024 Mar 19;19(1):10. doi: 10.1186/s13017-024-00536-9.
Tourniquets (TQ) have been increasingly adopted in pre-hospital settings recently. This study examined the effectiveness and safety of applying TQ in the pre-hospital settings for civilian patients with traumatic vascular injuries to the extremities.
We systematically searched the Ovid Embase, PubMed, and Cochrane Central Register of Controlled Trials databases from their inception to June 2023. We compared pre-hospital TQ (PH-TQ) use to no PH-TQ, defined as a TQ applied after hospital arrival or no TQ use at all, for civilian vascular extremity trauma patients. The primary outcome was overall mortality rate, and the secondary outcomes were blood product use and hospital stay. We analyzed TQ-related complications as safety outcomes. We tried to include randomized controlled trials (RCTs) and non-randomized studies (including non-RCTs, interrupted time series, controlled before-and-after studies, cohort studies, and case-control studies), if available. Pooled odds ratios (ORs) were calculated and the certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology.
Seven studies involving 4,095 patients were included. In the primary outcome, pre-hospital TQ (PH-TQ) use significantly decrease mortality rate in patients with extremity trauma (odds ratio [OR], 0.48, 95% confidence interval [CI] 0.27-0.86, I = 47%). Moreover, the use of PH-TQ showed the decreasing trend of utilization of blood products, such as packed red blood cells (mean difference [MD]: -2.1 [unit], 95% CI: -5.0 to 0.8, I = 99%) or fresh frozen plasma (MD: -1.0 [unit], 95% CI: -4.0 to 2.0, I = 98%); however, both are not statistically significant. No significant differences were observed in the lengths of hospital and intensive care unit stays. For the safety outcomes, PH-TQ use did not significantly increase risk of amputation (OR: 0.85, 95% CI: 0.43 to 1.68, I = 60%) or compartment syndrome (OR: 0.94, 95% CI: 0.37 to 2.35, I = 0%). The certainty of the evidence was very low across all outcomes.
The current data suggest that, in the pre-hospital settings, PH-TQ use for civilian patients with vascular traumatic injury of the extremities decreased mortality and tended to decrease blood transfusions. This did not increase the risk of amputation or compartment syndrome significantly.
最近，止血带（TQ）在院前环境中越来越多地被采用。本研究旨在评估在院前环境中为四肢创伤性血管损伤的平民患者使用止血带的效果和安全性。
我们系统地检索了 Ovid Embase、PubMed 和 Cochrane 对照试验中心注册数据库，检索时间从建库至 2023 年 6 月。我们将院前 TQ（PH-TQ）使用与非 PH-TQ 进行了比较，非 PH-TQ 定义为在到达医院后使用 TQ 或根本不使用 TQ。研究对象为平民血管外创伤患者。主要结局是总体死亡率，次要结局是血液制品使用和住院时间。我们将 TQ 相关并发症作为安全性结局进行分析。如果有随机对照试验（RCT）和非随机研究（包括非 RCT、中断时间序列、对照前后研究、队列研究和病例对照研究），我们也会纳入。计算汇总比值比（OR），并使用推荐评估、制定与评价（GRADE）方法评估证据质量。
共纳入 7 项涉及 4095 例患者的研究。在主要结局方面，院前 TQ（PH-TQ）的使用显著降低了四肢创伤患者的死亡率（OR，0.48，95%CI，0.27-0.86，I2=47%）。此外，PH-TQ 的使用显示出血液制品（如浓缩红细胞[MD：-2.1[单位]，95%CI：-5.0 至 0.8，I2=99%]或新鲜冷冻血浆[MD：-1.0[单位]，95%CI：-4.0 至 2.0，I2=98%]）使用量减少的趋势，但均无统计学意义。两组患者的住院和重症监护病房住院时间无显著差异。对于安全性结局，PH-TQ 的使用并未显著增加截肢（OR：0.85，95%CI：0.43 至 1.68，I2=60%）或筋膜间室综合征（OR：0.94，95%CI：0.37 至 2.35，I2=0%）的风险。所有结局的证据确定性均非常低。
目前的数据表明，在院前环境中，PH-TQ 用于四肢创伤性血管损伤的平民患者可降低死亡率，并可能减少血液制品的输注。这并未显著增加截肢或筋膜间室综合征的风险。
