Tourniquet usage in prehospital care and resuscitation of pediatric trauma patients-Pediatric Trauma Society position statement

Aaron Cunningham, Marc Auerbach, Mark Cicero, Mubeen Jafri

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

BACKGROUND Recent mass casualty events in the United States have highlighted the need for public preparedness to prevent death from uncontrolled hemorrhage. The Pediatric Trauma Society (PTS) reviewed the literature regarding pediatric tourniquet usage with the aim to provide recommendations about the utility of this adjunct for hemorrhage control in children. METHODS Search terms "pediatric" and "tourniquet" were used to query the US National Library of Medicine National Institutes of Health for pertinent literature. Exclusion criteria include not involving children, not involving the use of an extremity tourniquet, primary outcomes not related to hemorrhage control, tourniquet use to prevent snake envenomation, single case reports, and only foreign language formats available. Bibliographies of remaining studies reviewed to identify additional pertinent research. Four physician members of the PTS Guidelines Committee reviewed identified studies. RESULTS One hundred thirty-four studies were identified. One hundred twenty-three studies were excluded. Seven additional studies were identified through bibliography review. Eighteen pertinent studies were reviewed. Seven articles evaluated physiologic response to tourniquet use in operating room settings. Six articles were generated from combat experience in conflicts in Afghanistan and Iraq. Four articles discussed technical details of tourniquet usage. One article evaluated the use of tourniquets during the Boston Marathon bombing in 2015. CONCLUSION Despite limited data of limited quality regarding their use, the PTS supports the usage of tourniquets in the prehospital setting and during the resuscitation of children suffering from exsanguinating hemorrhage from severe extremity trauma. Expedited, definitive care must be sought, and tourniquet pressure and time should be limited to the least amount possible. The Society supports the ACS "Stop the Bleed" campaign and encourages further investigation of tourniquet use in children.

Original languageEnglish (US)
Pages (from-to)665-667
Number of pages3
JournalJournal of Trauma and Acute Care Surgery
Volume85
Issue number4
DOIs
StatePublished - Oct 1 2018

Fingerprint

Tourniquets
Resuscitation
Pediatrics
Wounds and Injuries
Bibliography
Hemorrhage
Extremities
Mass Casualty Incidents
Exsanguination
National Library of Medicine (U.S.)
Snake Bites
Afghanistan
Iraq
National Institutes of Health (U.S.)
Operating Rooms
Language
Guidelines
Physicians
Pressure

Keywords

  • "Stop the Bleed"
  • extremity trauma
  • hemorrhage control
  • Pediatric
  • tourniquet

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Tourniquet usage in prehospital care and resuscitation of pediatric trauma patients-Pediatric Trauma Society position statement. / Cunningham, Aaron; Auerbach, Marc; Cicero, Mark; Jafri, Mubeen.

In: Journal of Trauma and Acute Care Surgery, Vol. 85, No. 4, 01.10.2018, p. 665-667.

Research output: Contribution to journalArticle

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N2 - BACKGROUND Recent mass casualty events in the United States have highlighted the need for public preparedness to prevent death from uncontrolled hemorrhage. The Pediatric Trauma Society (PTS) reviewed the literature regarding pediatric tourniquet usage with the aim to provide recommendations about the utility of this adjunct for hemorrhage control in children. METHODS Search terms "pediatric" and "tourniquet" were used to query the US National Library of Medicine National Institutes of Health for pertinent literature. Exclusion criteria include not involving children, not involving the use of an extremity tourniquet, primary outcomes not related to hemorrhage control, tourniquet use to prevent snake envenomation, single case reports, and only foreign language formats available. Bibliographies of remaining studies reviewed to identify additional pertinent research. Four physician members of the PTS Guidelines Committee reviewed identified studies. RESULTS One hundred thirty-four studies were identified. One hundred twenty-three studies were excluded. Seven additional studies were identified through bibliography review. Eighteen pertinent studies were reviewed. Seven articles evaluated physiologic response to tourniquet use in operating room settings. Six articles were generated from combat experience in conflicts in Afghanistan and Iraq. Four articles discussed technical details of tourniquet usage. One article evaluated the use of tourniquets during the Boston Marathon bombing in 2015. CONCLUSION Despite limited data of limited quality regarding their use, the PTS supports the usage of tourniquets in the prehospital setting and during the resuscitation of children suffering from exsanguinating hemorrhage from severe extremity trauma. Expedited, definitive care must be sought, and tourniquet pressure and time should be limited to the least amount possible. The Society supports the ACS "Stop the Bleed" campaign and encourages further investigation of tourniquet use in children.

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