MSS06: BLEEDING OUT: IMPROVISED VERSUS COMMERCIAL TOURNIQUETS FOR THE CONTROL OF JUNCTIONAL HEMORRHAGE
Andrew H Tran, MD1; Aaron Weiland1; Jennifer DeMarco, MD1; Gabriel Atchison, EMTP1; Emmalena Kelly, DO2; Vanessa P Ho, MD, MPH, PhD, FACS1; Scott Powers, MD1; Casey Kohler, MD1; Nimitt Patel, MD1; Peter Zmijewski, MD1; 1MetroHealth Medical Center; 2Carl R. Darnall Army Medical Center
Objective: Junctional hemorrhage, defined as bleeding in the groin or axilla, cannot be controlled with standard extremity tourniquets (ET) and accounted for 19% of battlefield deaths in recent conflicts. Although commercial junctional tourniquets (cJT) exist, they are often not carried due to cost and availability; some suggest using improvised junctional tourniquets (iJT, Figure) fashioned from commonly available items instead. Our aims were to assess 1) the efficacy of iJT compared with cJT and 2) the importance of prior experience for successful iJT application.
Methods: ET, cJT, and iJT were applied to lower extremities of healthy adult volunteers. Successful application was defined as loss of pedal doppler signals. Time to occlusion (seconds), participant age, gender, BMI, and thigh/waist circumference were also collected. iJT and cJT were compared, as well as success rates for expert and novice applicators. ET were utilized as a control group. Factors associated with iJT failure were assessed with logistic regression.
Results: 275 tourniquets were applied to 70 volunteer extremities (30% female, Median age 34, median BMI 28.1). ET achieved occlusion in all applications (n=70). iJT achieved fewer occlusions compared to cJT (74% vs 94%, p < 0.001). cJT achieved occlusion faster compared to iJT (42.7 vs 66.5, p = 0.02). Females experienced more iJT failure (45% vs 17%, p = 0.001). Experts achieved higher occlusion rates compared to novices (78% vs 55%, p = 0.022). In logistic regression (Table), female gender was associated with increased likelihood of iJT failure, as was increased BMI and novice experience.
Conclusion: Although iJT achieved lower arterial occlusion rates compared to cJT, iJT show promise as these methods used common materials, were quickly applied, could be used by a novice, and successfully occluded arterial flow in the majority of applications. Further work must identify optimal methodology and materials to construct a reliable iJT.
| Odds Ratio | 95% Confidence Interval | P value | |
| Female Gender | 5.65 |
2.19 – 14.56 |
<0.001 |
| BMI | 1.11 |
1.01 – 1.22 |
0.03 |
|
Waist Circumference |
1.00 | 0.96 – 1.05 | 0.79 |
|
Thigh Circumference |
0.96 |
0.90 – 1.02 |
0.20 |
|
Novice Applicator |
3.41 |
1.15 – 10.15 |
0.03 |