Prehospital tourniquet use tied to improved mobility and limb preservation in vascular extremity trauma

According to a recent study published in Surgery, researchers from Case Western Reserve University, Cleveland, said that Encouraging tourniquet use in the civilian setting may improve outcomes and reduce limb loss risk, as it has been associated with increased functional mobility and decreased delayed amputation.

The researchers in this study established the Hypothesis that Prehospital tourniquet use in vascular extremity trauma reduces delayed amputation and improves mobility compared to no prehospital tourniquet application.

The team evaluated adults with extremity vascular trauma at an urban Level 1 trauma centre (2016-2021). Outcomes included delayed amputation and mobility at discharge, measured by the 6 Clicks Basic Mobility Score. Higher scores indicated better mobility. Data on injury mechanisms, lactate, transfusions, mortality, and kidney injury were also collected. χ2, Fisher Exact and Wilcoxon tests were used to perform comparisons.

The results of this study could be summarised as follows:

• Of 232 patients, prehospital tourniquet application had no association with mortality or lactate level.
• The prehospital tourniquet application group had more transfusions, lower acute kidney injury rates, and fewer delayed amputations.
• Ninety-one patients, (45 in prehospital tourniquet application and 46 without it) were evaluated for "Moving between Bed and Chair" in the "6 Clicks" Basic Mobility Score. Those in the prehospital tourniquet application group had higher levels of independence.

In this study, they said we used the "6 Clicks" score to assess the differences in functional mobility between patients who had extremity vascular trauma with and without tourniquet use.

The use of Prehospital tourniquets was associated with fewer delayed amputations. The outcomes were favourable, including higher functional mobility and decreased delayed amputation.

The results of this study suggest that tourniquet use should be encouraged in the civilian setting as it improves outcomes and reduces limb loss risk.

Reference:

Thai, A. P., Tseng, E. S., Kishawi, S., Robenstine, J. C., & Ho, V. P. (2023). Prehospital tourniquet application in extremity vascular trauma: Improved functional outcomes. Surgery, 174(6), 1471–1475. https://doi.org/10.1016/j.surg.2023.08.002