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John F Kragh - One of the best experts on this subject based on the ideXlab platform.
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transfusion for shock in us military war casualties with and without Tourniquet use
Annals of Emergency Medicine, 2015Co-Authors: John F Kragh, Thomas J Walters, David G Baer, Jason J Nam, Keith A Berry, Vincent J Mase, James K Aden, Michael A Dubick, Charles E WadeAbstract:Study objective We assess whether emergency Tourniquet use for transfused war casualties admitted to military hospitals is associated with survival. Methods A retrospective review of trauma registry data was made of US casualties in Afghanistan and Iraq. Patients with major limb trauma, transfusion, and Tourniquet use were compared with similar patients who did not receive Tourniquet use. A propensity-matching analysis was performed by stratifying for injury type and severity by Tourniquet-use status. Additionally, direct comparison without propensity matching was made between Tourniquet use and no-Tourniquet use groups. Results There were 720 casualties in the Tourniquet use and 693 in the no-Tourniquet use groups. Of the 1,413 casualties, 66% (928) also had nonextremity injury. Casualties with Tourniquet use had worse signs of hemorrhagic shock (admission base deficit, admission hemoglobin, admission pulse, and transfusion units required) than those without. Survival rates were similar between the 2 groups (1% difference; 95% confidence interval −2.5% to 4.2%), but casualties who received Tourniquets had worse shock and received more blood products. In propensity-matched casualties, survival rates were not different (2% difference; 95% confidence interval −6.7% to 2.7%) between the 2 groups. Conclusion Tourniquet use was associated with worse shock and more transfusion requirements among hospital-admitted casualties, yet those who received Tourniquets had survival rates similar to those of comparable, transfused casualties who did not receive Tourniquets.
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Emergency Tourniquet effectiveness in four positions on the proximal thigh
Journal of special operations medicine : a peer reviewed journal for SOF medical professionals, 2014Co-Authors: John F Kragh, James K Aden, Michael A Dubick, Timothy E. Wallum, David G BaerAbstract:Abstract : Objective: The purpose of the present study is to determine the performance of Tourniquet use by the placement of the Tourniquet s windlass on the extremity in four positions medial, lateral, anterior, and posterior to inform Tourniquet instructors and develop best Tourniquet practices. Methods: A HapMed Leg Tourniquet Trainer was used as a manikin to test the effectiveness of an emergency Tourniquet, the Special Operations Forces Tactical Tourniquet. Two users made 10 tests, each in four positions. Results: Effectiveness rates of Tourniquet use were 100% in all four positions. The two Tourniquet users were both right-hand dominant and used their right hand to turn the windlass. One user turned the windlass clockwise, and the other turned it counterclockwise. The association between time to stop bleeding and Tourniquet position was statistically significant but associations between time to stop bleeding and the user, user-by-position, and windlass turn number were not statistically significant. The association between Tourniquet position and pressure under the Tourniquet was statistically significant, and the association between user and pressure under the Tourniquet was statistically significant, but the user-byposition and windlass turn number were not statistically significant. The associations between Tourniquet position and blood loss volume, user and blood loss volume, and user-by-position and blood loss volume were statistically significant. Conclusions: The present study found that Tourniquet effectiveness rates were uniformly 100% irrespective of whether the windlass position was medial, lateral, anterior, or posterior. These excellent clinical and statistical results indicate that users may continue to place the Tourniquets as they prefer upon the proximal thigh.
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survey of trauma registry data on Tourniquet use in pediatric war casualties
Pediatric Emergency Care, 2012Co-Authors: John F Kragh, David G Baer, Charles E Wade, James K Aden, Michael A Dubick, þ Arthur Cooper, Lorne H BlackbourneAbstract:OBJECTIVES Previously, we reported on the use of emergency Tourniquets to stop bleeding in war casualties, but virtually all the data were from adults. Because no pediatric-specific cohort of casualties receiving emergency Tourniquets existed, we aimed to fill knowledge gaps on the care and outcomes of this group by surveying data from a trauma registry to refine device designs and clinical training. METHODS A retrospective review of data from a trauma registry yielded an observational cohort of 88 pediatric casualties at US military hospitals in theater on whom Tourniquets were used from May 17, 2003, to December 25, 2009. RESULTS Of the 88 casualties in the study group, 72 were male and 16 were female patients. Ages averaged 11 years (median, 11 years; range, 4-17 years). There were 7 dead and 81 survivor outcomes for a trauma survival rate of 93%. Survivor and dead casualties were similar in all independent variables measured except hospital stay duration (median, 5 days and 1 day, respectively). Six casualties (7%) had neither extremity nor external injury in that they had no lesion indicating Tourniquet use. CONCLUSIONS The survival rate of the present study's casualties is similar to that of 3 recent large nonpediatric-specific studies. Although current emergency Tourniquets were ostensibly designed for modern adult soldiers, Tourniquet makers, perhaps unknowingly, produced Tourniquets that fit children. The rate of unindicated Tourniquets, 7%, implied that potential users need better diagnostic training. LEVELS OF EVIDENCE Level 4; case series, therapeutic study.
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historical review of emergency Tourniquet use to stop bleeding
American Journal of Surgery, 2012Co-Authors: John F Kragh, Kenneth G Swan, Dale C Smith, Robert L Mabry, Lorne H BlackbourneAbstract:Abstract Background Although a common first aid topic, emergency Tourniquets to stop bleeding are controversial because there is little experience on which to guide use. Absent an adequate historical analysis, we have researched development of emergency Tourniquets from antiquity to the present. Methods We selected sources emphasizing historical development of Tourniquets from books and databases such as PubMed. Results The history of the emergency Tourniquet is long and disjointed, mainly written by hospital surgeons with little accounting, until recently, of the needs of forward medics near the point injury. Many investigators often are unaware of the breadth of the Tourniquet’s history and voice opinions based on anecdotal observations. Conclusions Reporting the historical development of Tourniquet use allowed us to recognize disparate problems investigators discuss but do not recognize, such as venous Tourniquet use. We relate past observations with recent observations for use by subsequent investigators.
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battle casualty survival with emergency Tourniquet use to stop limb bleeding
Journal of Emergency Medicine, 2011Co-Authors: John F Kragh, Thomas J Walters, David G Baer, Charles E Wade, Michelle L Littrel, John A Jones, John B HolcombAbstract:Abstract Background In a previous study conducted at a combat support hospital in Iraq, we reported the major lifesaving benefits of emergency Tourniquets to stop bleeding in major limb trauma. Morbidity associated with Tourniquet use was minor. Study Objectives The objective of this study is to further analyze emergency Tourniquet use in combat casualty care. Design and Setting This report is a continuation of our previous study of Tourniquet use in casualties admitted to a combat support hospital (NCT00517166 at www.ClinicalTrials.gov). Methods After verifying comparable methodologies for the first study and the current study, we compared patient results for these two time periods and then pooled data to analyze outcomes with a larger sample size. Results The total study population was 499 (232 in the previous study and 267 in the current study). In all, 862 Tourniquets were applied on 651 limbs. Survival was 87% for both study periods. Morbidity rates for palsies at the level of the Tourniquet were 1.7% for study 1 and 1.5% for study 2; major limb shortening was 0.4% for both. Survival was associated with prehospital application (89% vs. 78% hospital, p Conclusions This study shows consistent lifesaving benefits and low risk of emergency Tourniquets to stop bleeding in major limb trauma.
Charles E Wade - One of the best experts on this subject based on the ideXlab platform.
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the trauma center is too late major limb trauma without a pre hospital Tourniquet has increased death from hemorrhagic shock
Journal of Trauma-injury Infection and Critical Care, 2017Co-Authors: Michelle H. Scerbo, Charles E Wade, John B Holcomb, Keith Gates, Joseph D. Love, Ethan A Taub, Bryan A. CottonAbstract:BACKGROUNDTo date, no civilian studies have demonstrated that pre-hospital (PH) Tourniquets improve survival. We hypothesized that late, trauma center (TC) Tourniquet use would increase death from hemorrhagic shock compared to early (PH) placement.METHODSAll patients arriving to a Level 1, urban TC
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Safety and Appropriateness of Tourniquets in 105 Civilians.
Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 2016Co-Authors: Michelle H. Scerbo, Charles E Wade, John B Holcomb, Jacob P Mumm, Keith Gates, Joseph D. Love, Bryan A. CottonAbstract:The United States military considers Tourniquets to be effective for controlling bleeding from major limb trauma. The purpose of this study was to assess whether Tourniquets are safely applied to the appropriate civilian patient with major limb trauma of any etiology. Following IRB approval, patients arriving to a level-1 trauma center between October 2008 and May 2013 with a prehospital (PH) or emergency department (ED) Tourniquet were reviewed. Cases were assigned the following designations: absolute indication (operation within 2 hours for limb injury, vascular injury requiring repair/ligation, or traumatic amputation); relative indication (major musculoskeletal/soft-tissue injury requiring operation 2-8 hours after arrival, documented large blood loss); and non-indicated. Patients with absolute or relative indications for Tourniquet placement were defined as indicated, while the remaining were designated as non-indicated. Complications potentially associated with Tourniquets, including amputation, acute renal failure, compartment syndrome, nerve palsies, and venous thromboembolic events, were adjudicated by orthopedic, hand or trauma surgical staff. Univariate analysis was performed to compare patients with indicated versus non-indicated Tourniquet placement. A total of 105 patients received a Tourniquet for injuries sustained via sharp objects, i.e., glass or knives (32%), motor vehicle collisions (30%), or other mechanisms (38%). A total of 94 patients (90%) had indicated Tourniquet placement; 41 (44%) of which had a vascular injury. Demographics, mechanism, transport, and vitals were similar between patients that had indicated or non-indicated Tourniquet placement. 48% of the indicated Tourniquets placed PH were removed in the ED, compared to 100% of the non-indicated Tourniquets (p < 0.01). The amputation rate was 32% among patients with indicated Tourniquet placement (vs. 0%; p = 0.03). Acute renal failure (3.2 vs. 0%, p = 0.72), compartment syndrome (2.1 vs. 0%, p = 0.80), nerve palsies (5.3 vs. 0%; p = 0.57), and venous thromboembolic events (9.1 vs. 8.5%; p = 0.65) and were similar in patients that had indicated compared to non-indicated Tourniquet placement. After adjudication, no complication was a result of Tourniquet use. The current study suggests that PH and ED Tourniquets are used safely and appropriately in civilians with major limb trauma that occur via blunt and penetrating mechanisms.
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transfusion for shock in us military war casualties with and without Tourniquet use
Annals of Emergency Medicine, 2015Co-Authors: John F Kragh, Thomas J Walters, David G Baer, Jason J Nam, Keith A Berry, Vincent J Mase, James K Aden, Michael A Dubick, Charles E WadeAbstract:Study objective We assess whether emergency Tourniquet use for transfused war casualties admitted to military hospitals is associated with survival. Methods A retrospective review of trauma registry data was made of US casualties in Afghanistan and Iraq. Patients with major limb trauma, transfusion, and Tourniquet use were compared with similar patients who did not receive Tourniquet use. A propensity-matching analysis was performed by stratifying for injury type and severity by Tourniquet-use status. Additionally, direct comparison without propensity matching was made between Tourniquet use and no-Tourniquet use groups. Results There were 720 casualties in the Tourniquet use and 693 in the no-Tourniquet use groups. Of the 1,413 casualties, 66% (928) also had nonextremity injury. Casualties with Tourniquet use had worse signs of hemorrhagic shock (admission base deficit, admission hemoglobin, admission pulse, and transfusion units required) than those without. Survival rates were similar between the 2 groups (1% difference; 95% confidence interval −2.5% to 4.2%), but casualties who received Tourniquets had worse shock and received more blood products. In propensity-matched casualties, survival rates were not different (2% difference; 95% confidence interval −6.7% to 2.7%) between the 2 groups. Conclusion Tourniquet use was associated with worse shock and more transfusion requirements among hospital-admitted casualties, yet those who received Tourniquets had survival rates similar to those of comparable, transfused casualties who did not receive Tourniquets.
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survey of trauma registry data on Tourniquet use in pediatric war casualties
Pediatric Emergency Care, 2012Co-Authors: John F Kragh, David G Baer, Charles E Wade, James K Aden, Michael A Dubick, þ Arthur Cooper, Lorne H BlackbourneAbstract:OBJECTIVES Previously, we reported on the use of emergency Tourniquets to stop bleeding in war casualties, but virtually all the data were from adults. Because no pediatric-specific cohort of casualties receiving emergency Tourniquets existed, we aimed to fill knowledge gaps on the care and outcomes of this group by surveying data from a trauma registry to refine device designs and clinical training. METHODS A retrospective review of data from a trauma registry yielded an observational cohort of 88 pediatric casualties at US military hospitals in theater on whom Tourniquets were used from May 17, 2003, to December 25, 2009. RESULTS Of the 88 casualties in the study group, 72 were male and 16 were female patients. Ages averaged 11 years (median, 11 years; range, 4-17 years). There were 7 dead and 81 survivor outcomes for a trauma survival rate of 93%. Survivor and dead casualties were similar in all independent variables measured except hospital stay duration (median, 5 days and 1 day, respectively). Six casualties (7%) had neither extremity nor external injury in that they had no lesion indicating Tourniquet use. CONCLUSIONS The survival rate of the present study's casualties is similar to that of 3 recent large nonpediatric-specific studies. Although current emergency Tourniquets were ostensibly designed for modern adult soldiers, Tourniquet makers, perhaps unknowingly, produced Tourniquets that fit children. The rate of unindicated Tourniquets, 7%, implied that potential users need better diagnostic training. LEVELS OF EVIDENCE Level 4; case series, therapeutic study.
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battle casualty survival with emergency Tourniquet use to stop limb bleeding
Journal of Emergency Medicine, 2011Co-Authors: John F Kragh, Thomas J Walters, David G Baer, Charles E Wade, Michelle L Littrel, John A Jones, John B HolcombAbstract:Abstract Background In a previous study conducted at a combat support hospital in Iraq, we reported the major lifesaving benefits of emergency Tourniquets to stop bleeding in major limb trauma. Morbidity associated with Tourniquet use was minor. Study Objectives The objective of this study is to further analyze emergency Tourniquet use in combat casualty care. Design and Setting This report is a continuation of our previous study of Tourniquet use in casualties admitted to a combat support hospital (NCT00517166 at www.ClinicalTrials.gov). Methods After verifying comparable methodologies for the first study and the current study, we compared patient results for these two time periods and then pooled data to analyze outcomes with a larger sample size. Results The total study population was 499 (232 in the previous study and 267 in the current study). In all, 862 Tourniquets were applied on 651 limbs. Survival was 87% for both study periods. Morbidity rates for palsies at the level of the Tourniquet were 1.7% for study 1 and 1.5% for study 2; major limb shortening was 0.4% for both. Survival was associated with prehospital application (89% vs. 78% hospital, p Conclusions This study shows consistent lifesaving benefits and low risk of emergency Tourniquets to stop bleeding in major limb trauma.
David G Baer - One of the best experts on this subject based on the ideXlab platform.
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transfusion for shock in us military war casualties with and without Tourniquet use
Annals of Emergency Medicine, 2015Co-Authors: John F Kragh, Thomas J Walters, David G Baer, Jason J Nam, Keith A Berry, Vincent J Mase, James K Aden, Michael A Dubick, Charles E WadeAbstract:Study objective We assess whether emergency Tourniquet use for transfused war casualties admitted to military hospitals is associated with survival. Methods A retrospective review of trauma registry data was made of US casualties in Afghanistan and Iraq. Patients with major limb trauma, transfusion, and Tourniquet use were compared with similar patients who did not receive Tourniquet use. A propensity-matching analysis was performed by stratifying for injury type and severity by Tourniquet-use status. Additionally, direct comparison without propensity matching was made between Tourniquet use and no-Tourniquet use groups. Results There were 720 casualties in the Tourniquet use and 693 in the no-Tourniquet use groups. Of the 1,413 casualties, 66% (928) also had nonextremity injury. Casualties with Tourniquet use had worse signs of hemorrhagic shock (admission base deficit, admission hemoglobin, admission pulse, and transfusion units required) than those without. Survival rates were similar between the 2 groups (1% difference; 95% confidence interval −2.5% to 4.2%), but casualties who received Tourniquets had worse shock and received more blood products. In propensity-matched casualties, survival rates were not different (2% difference; 95% confidence interval −6.7% to 2.7%) between the 2 groups. Conclusion Tourniquet use was associated with worse shock and more transfusion requirements among hospital-admitted casualties, yet those who received Tourniquets had survival rates similar to those of comparable, transfused casualties who did not receive Tourniquets.
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Emergency Tourniquet effectiveness in four positions on the proximal thigh
Journal of special operations medicine : a peer reviewed journal for SOF medical professionals, 2014Co-Authors: John F Kragh, James K Aden, Michael A Dubick, Timothy E. Wallum, David G BaerAbstract:Abstract : Objective: The purpose of the present study is to determine the performance of Tourniquet use by the placement of the Tourniquet s windlass on the extremity in four positions medial, lateral, anterior, and posterior to inform Tourniquet instructors and develop best Tourniquet practices. Methods: A HapMed Leg Tourniquet Trainer was used as a manikin to test the effectiveness of an emergency Tourniquet, the Special Operations Forces Tactical Tourniquet. Two users made 10 tests, each in four positions. Results: Effectiveness rates of Tourniquet use were 100% in all four positions. The two Tourniquet users were both right-hand dominant and used their right hand to turn the windlass. One user turned the windlass clockwise, and the other turned it counterclockwise. The association between time to stop bleeding and Tourniquet position was statistically significant but associations between time to stop bleeding and the user, user-by-position, and windlass turn number were not statistically significant. The association between Tourniquet position and pressure under the Tourniquet was statistically significant, and the association between user and pressure under the Tourniquet was statistically significant, but the user-byposition and windlass turn number were not statistically significant. The associations between Tourniquet position and blood loss volume, user and blood loss volume, and user-by-position and blood loss volume were statistically significant. Conclusions: The present study found that Tourniquet effectiveness rates were uniformly 100% irrespective of whether the windlass position was medial, lateral, anterior, or posterior. These excellent clinical and statistical results indicate that users may continue to place the Tourniquets as they prefer upon the proximal thigh.
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survey of trauma registry data on Tourniquet use in pediatric war casualties
Pediatric Emergency Care, 2012Co-Authors: John F Kragh, David G Baer, Charles E Wade, James K Aden, Michael A Dubick, þ Arthur Cooper, Lorne H BlackbourneAbstract:OBJECTIVES Previously, we reported on the use of emergency Tourniquets to stop bleeding in war casualties, but virtually all the data were from adults. Because no pediatric-specific cohort of casualties receiving emergency Tourniquets existed, we aimed to fill knowledge gaps on the care and outcomes of this group by surveying data from a trauma registry to refine device designs and clinical training. METHODS A retrospective review of data from a trauma registry yielded an observational cohort of 88 pediatric casualties at US military hospitals in theater on whom Tourniquets were used from May 17, 2003, to December 25, 2009. RESULTS Of the 88 casualties in the study group, 72 were male and 16 were female patients. Ages averaged 11 years (median, 11 years; range, 4-17 years). There were 7 dead and 81 survivor outcomes for a trauma survival rate of 93%. Survivor and dead casualties were similar in all independent variables measured except hospital stay duration (median, 5 days and 1 day, respectively). Six casualties (7%) had neither extremity nor external injury in that they had no lesion indicating Tourniquet use. CONCLUSIONS The survival rate of the present study's casualties is similar to that of 3 recent large nonpediatric-specific studies. Although current emergency Tourniquets were ostensibly designed for modern adult soldiers, Tourniquet makers, perhaps unknowingly, produced Tourniquets that fit children. The rate of unindicated Tourniquets, 7%, implied that potential users need better diagnostic training. LEVELS OF EVIDENCE Level 4; case series, therapeutic study.
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battle casualty survival with emergency Tourniquet use to stop limb bleeding
Journal of Emergency Medicine, 2011Co-Authors: John F Kragh, Thomas J Walters, David G Baer, Charles E Wade, Michelle L Littrel, John A Jones, John B HolcombAbstract:Abstract Background In a previous study conducted at a combat support hospital in Iraq, we reported the major lifesaving benefits of emergency Tourniquets to stop bleeding in major limb trauma. Morbidity associated with Tourniquet use was minor. Study Objectives The objective of this study is to further analyze emergency Tourniquet use in combat casualty care. Design and Setting This report is a continuation of our previous study of Tourniquet use in casualties admitted to a combat support hospital (NCT00517166 at www.ClinicalTrials.gov). Methods After verifying comparable methodologies for the first study and the current study, we compared patient results for these two time periods and then pooled data to analyze outcomes with a larger sample size. Results The total study population was 499 (232 in the previous study and 267 in the current study). In all, 862 Tourniquets were applied on 651 limbs. Survival was 87% for both study periods. Morbidity rates for palsies at the level of the Tourniquet were 1.7% for study 1 and 1.5% for study 2; major limb shortening was 0.4% for both. Survival was associated with prehospital application (89% vs. 78% hospital, p Conclusions This study shows consistent lifesaving benefits and low risk of emergency Tourniquets to stop bleeding in major limb trauma.
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the military emergency Tourniquet program s lessons learned with devices and designs
Military Medicine, 2011Co-Authors: John F Kragh, Thomas J Walters, David G Baer, Charles E Wade, John B Holcomb, Michael A Dubick, Michelle L Oneill, Lorne H BlackbourneAbstract:ABSTRACTObjective: The purpose of this study is to report the device lessons learned from an emergency Tourniquet program and, in particular, to emphasize analysis of discarded devices recovered after clinical use. Methods: Discarded Tourniquet devices were analyzed after use in emergency care of war casualties to determine wear and tear patterns, effectiveness rates, and associations among device designs. Results: The 159 devices recovered comprised seven designs. Emergency & Military Tourniquet (92%) and Combat Application Tourniquet (79%) effectiveness rates were significantly different from each other and better than other Tourniquets (p < 0.002) as the most effective ambulance and field Tourniquets, respectively. Designs had specific pitfalls (e.g., sand-clogged ratchets) and strengths (the pneumatic design was least painful). Every device had wear, abrasions, or deformity about the band edges or bladder. User understanding of how devices work best helped attain better results. Some desirable traits ...
Charlotta Olivecrona - One of the best experts on this subject based on the ideXlab platform.
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Tourniquet time affects postoperative complications after knee arthroplasty
International Orthopaedics, 2013Co-Authors: Charlotta Olivecrona, Lasse J Lapidus, Lina Benson, Richard BlomfeldtAbstract:Purpose Pneumatic Tourniquets are frequently used in knee arthroplasty surgery. However, there is a lack of evidence to define safe Tourniquet time in lower limb surgery. The primary aim of this study was to investigate whether Tourniquet time influences the risk of postoperative complications after primary and secondary knee arthroplasty.
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skin protection underneath the pneumatic Tourniquet during total knee arthroplasty a randomized controlled trial of 92 patients
Acta Orthopaedica, 2006Co-Authors: Charlotta Olivecrona, Jan Tidermark, Per Hamberg, Sari Ponzer, Claes CederfjallAbstract:Background The use of a pneumatic Tourniquet to obtain a bloodless field during a total knee arthroplasty (TKA) allows the surgeon to work with greater technical precision in a safe, clear environment. Despite the benefits of surgical Tourniquets and many advances in Tourniquet equipment, their use is not without risk and complications may still occur. The primary aim of this study was to determine whether there are any differences between an elastic stockinette, cast padding, and no protective material at all regarding skin injuries after a primary TKA in a bloodless field using a pneumatic Tourniquet.Methods 92 patients were randomized to 1 of 3 groups. In the first group, the limb underneath the pneumatic Tourniquet was protected by a two-layer elastic stockinette (E). In the second group, it was protected by cast padding (C), and no protective material (N) was used in the third group. The presence of major skin injuries (blisters) was recorded when the Tourniquet was removed after surgery.Results The ...
Thomas J Walters - One of the best experts on this subject based on the ideXlab platform.
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transfusion for shock in us military war casualties with and without Tourniquet use
Annals of Emergency Medicine, 2015Co-Authors: John F Kragh, Thomas J Walters, David G Baer, Jason J Nam, Keith A Berry, Vincent J Mase, James K Aden, Michael A Dubick, Charles E WadeAbstract:Study objective We assess whether emergency Tourniquet use for transfused war casualties admitted to military hospitals is associated with survival. Methods A retrospective review of trauma registry data was made of US casualties in Afghanistan and Iraq. Patients with major limb trauma, transfusion, and Tourniquet use were compared with similar patients who did not receive Tourniquet use. A propensity-matching analysis was performed by stratifying for injury type and severity by Tourniquet-use status. Additionally, direct comparison without propensity matching was made between Tourniquet use and no-Tourniquet use groups. Results There were 720 casualties in the Tourniquet use and 693 in the no-Tourniquet use groups. Of the 1,413 casualties, 66% (928) also had nonextremity injury. Casualties with Tourniquet use had worse signs of hemorrhagic shock (admission base deficit, admission hemoglobin, admission pulse, and transfusion units required) than those without. Survival rates were similar between the 2 groups (1% difference; 95% confidence interval −2.5% to 4.2%), but casualties who received Tourniquets had worse shock and received more blood products. In propensity-matched casualties, survival rates were not different (2% difference; 95% confidence interval −6.7% to 2.7%) between the 2 groups. Conclusion Tourniquet use was associated with worse shock and more transfusion requirements among hospital-admitted casualties, yet those who received Tourniquets had survival rates similar to those of comparable, transfused casualties who did not receive Tourniquets.
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battle casualty survival with emergency Tourniquet use to stop limb bleeding
Journal of Emergency Medicine, 2011Co-Authors: John F Kragh, Thomas J Walters, David G Baer, Charles E Wade, Michelle L Littrel, John A Jones, John B HolcombAbstract:Abstract Background In a previous study conducted at a combat support hospital in Iraq, we reported the major lifesaving benefits of emergency Tourniquets to stop bleeding in major limb trauma. Morbidity associated with Tourniquet use was minor. Study Objectives The objective of this study is to further analyze emergency Tourniquet use in combat casualty care. Design and Setting This report is a continuation of our previous study of Tourniquet use in casualties admitted to a combat support hospital (NCT00517166 at www.ClinicalTrials.gov). Methods After verifying comparable methodologies for the first study and the current study, we compared patient results for these two time periods and then pooled data to analyze outcomes with a larger sample size. Results The total study population was 499 (232 in the previous study and 267 in the current study). In all, 862 Tourniquets were applied on 651 limbs. Survival was 87% for both study periods. Morbidity rates for palsies at the level of the Tourniquet were 1.7% for study 1 and 1.5% for study 2; major limb shortening was 0.4% for both. Survival was associated with prehospital application (89% vs. 78% hospital, p Conclusions This study shows consistent lifesaving benefits and low risk of emergency Tourniquets to stop bleeding in major limb trauma.
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the military emergency Tourniquet program s lessons learned with devices and designs
Military Medicine, 2011Co-Authors: John F Kragh, Thomas J Walters, David G Baer, Charles E Wade, John B Holcomb, Michael A Dubick, Michelle L Oneill, Lorne H BlackbourneAbstract:ABSTRACTObjective: The purpose of this study is to report the device lessons learned from an emergency Tourniquet program and, in particular, to emphasize analysis of discarded devices recovered after clinical use. Methods: Discarded Tourniquet devices were analyzed after use in emergency care of war casualties to determine wear and tear patterns, effectiveness rates, and associations among device designs. Results: The 159 devices recovered comprised seven designs. Emergency & Military Tourniquet (92%) and Combat Application Tourniquet (79%) effectiveness rates were significantly different from each other and better than other Tourniquets (p < 0.002) as the most effective ambulance and field Tourniquets, respectively. Designs had specific pitfalls (e.g., sand-clogged ratchets) and strengths (the pneumatic design was least painful). Every device had wear, abrasions, or deformity about the band edges or bladder. User understanding of how devices work best helped attain better results. Some desirable traits ...
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minor morbidity with emergency Tourniquet use to stop bleeding in severe limb trauma research history and reconciling advocates and abolitionists
Military Medicine, 2011Co-Authors: John F Kragh, Thomas J Walters, David G Baer, Charles E Wade, Michelle L Oneill, John A Jones, Leigh K Gershman, John B HolcombAbstract:ABSTRACTBackground: In prior reports of active data collection, we demonstrated that early use of emergency Tourniquets is associated with improved survival and only minor morbidity. To check these new and important results, we continued critical evaluation of Tourniquet use for 6 more months in the current study to see if results were consistent. Methods: We continued a prospective survey of casualties and their records at a combat support hospital in Baghdad who had Tourniquets used at a combat hospital in Baghdad (NCT00517166 at ClinicalTrials.gov). Results: After comparable methods were verified for both the first and current studies, we report the results of 499 patients who had 862 Tourniquets applied on 651 limbs. The clinical results were consistent. No limbs were lost from Tourniquet use. Conclusion: We found that morbidity was minor in light of major survival benefits consistent with prior reports.
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survival with emergency Tourniquet use to stop bleeding in major limb trauma
Annals of Surgery, 2009Co-Authors: John F Kragh, Thomas J Walters, David G Baer, Charles J Fox, Charles E Wade, Jose Salinas, John B HolcombAbstract:Abstract : Objective: The purpose of this study was to determine if emergency Tourniquet use saved lives. Summary Background Data: Tourniquets have been proposed as lifesaving devices in the current war and are now issued to all soldiers. Few studies, however, describe their actual use in combat casualties. Methods: A prospective survey of injured who required Tourniquets was performed over 7 months in 2006 (NCT00517166 at ClinicalTrials.gov). Follow-up averaged 28 days. The study was at a combat support hospital in Baghdad. Among 2838 injured and admitted civilian and military casualties with major limb trauma, 232 (8%) had 428 Tourniquets applied on 309 injured limbs. We looked at emergency Tourniquet use, and casualties were evaluated for shock (weak or absent radial pulse) and prehospital versus emergency department (ED) Tourniquet use. We also looked at those casualties indicated for Tourniquets but had none used. We assessed survival rates and limb outcome. Results: There were 31 deaths (13%). Tourniquet use when shock was absent was strongly associated with survival (90% vs. 10%; P less than 0.001). Prehospital Tourniquets were applied in 194 patients of which 22 died (11% mortality), whereas 38 patients had ED application of which 9 died (24% mortality; P less than 0.05). The 5 casualties indicated for Tourniquets but had none used had a survival rate of 0% versus 87% for those casualties with Tourniquets used ( P less than 0.001). Four patients (1.7%) sustained transient nerve palsy at the level of the Tourniquet. No amputations resulted solely from Tourniquet use. Conclusions: Tourniquet use when shock was absent was strongly associated with saved lives, and prehospital use was also strongly associated with lifesaving. No limbs were lost due to Tourniquet use. Education and fielding of prehospital Tourniquets in the military environment should continue.
