Abstract

Objectives: This systematic review seeks to offer an overview of the current level of knowledge about the clinical efficacy of prehospital tourniquets (TQ).
Methods: A comprehensive search of relevant databases was conducted to identify studies that met the inclusion criteria. PubMed, Science Direct, and Scopus were systematically searched for relevant literature. Rayyan QRCI was employed throughout this comprehensive process.
Results: Our results included eight studies with a total of 1,434 patients with 1,058 (73.8%). The eight studies were retrospective in nature. TQ application time ranged from 15 minutes to 190 minutes. There were significantly fewer delayed amputations, fewer fatal hemorrhages, fewer acute renal damage cases, more transfusions in those who underwent the prehospital TQ, the average systolic blood pressure of patients in the TQ
group was higher, less fresh frozen plasma, less total packed red blood cells, fewer fasciotomy, and less vascular injury in patients with penetrating traumas. Complications included limb ischemia and/or reperfusion damage, temporary sensory impairment, temporary mixed motor and sensory loss, and peroneal nerve palsy. One study reported that in the prehospital TQ group, amputation rates were 8.3%, while in the No-prehospital
TQ group, they were 0%.
Conclusion: The studies consistently found that in civilian settings, using a TQ to halt uncontrollably bleeding extremities was associated with a better chance of survival in penetrating injuries. Application times of less than 2 hours appeared to be quite safe in previously healthy persons, while problems with TQ usage appeared to be directly connected to application times. Subsequent research, ideally in the form of randomized controlled trials, should be done to validate the initial findings of observational studies.

Key words: Tourniquets; limb; trauma; emergency; prehospital; systematic review.