Is the Use of Tourniquets More Advantageous than Other Bleeding Control Techniques in Patients with Limb Hemorrhage? A Systematic Review and Meta-Analysis
<i>Background and Objectives:</i> Trauma, particularly uncontrolled bleeding, is a major cause of death. Recent evidence-based guidelines recommend the use of a tourniquet when life-threating limb bleeding cannot be controlled with direct pressure. Prehospital hemorrhage management, acco...
Saved in:
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2025-01-01
|
| Series: | Medicina |
| Subjects: | |
| Online Access: | https://www.mdpi.com/1648-9144/61/1/93 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832588028304949248 |
|---|---|
| author | Roberto Cirocchi Dominica Prigorschi Luca Properzi Matteo Matteucci Francesca Duro Giovanni Domenico Tebala Bruno Cirillo Paolo Sapienza Gioia Brachini Sara Lauricella Diletta Cassini Antonia Rizzuto Andrea Mingoli |
| author_facet | Roberto Cirocchi Dominica Prigorschi Luca Properzi Matteo Matteucci Francesca Duro Giovanni Domenico Tebala Bruno Cirillo Paolo Sapienza Gioia Brachini Sara Lauricella Diletta Cassini Antonia Rizzuto Andrea Mingoli |
| author_sort | Roberto Cirocchi |
| collection | DOAJ |
| description | <i>Background and Objectives:</i> Trauma, particularly uncontrolled bleeding, is a major cause of death. Recent evidence-based guidelines recommend the use of a tourniquet when life-threating limb bleeding cannot be controlled with direct pressure. Prehospital hemorrhage management, according to the XABCDE protocol, emphasizes the critical role of tourniquets in controlling massive bleeding. The aim of this systematic review and meta-analysis was to summarize data from the available scientific literature on the effectiveness of prehospital tourniquet use for extremity bleeding. <i>Materials and Methods:</i> A systematic review and meta-analysis was performed between March 2022 and March 2024, adhering to PRISMA guidelines, to determine whether prehospital tourniquets are clinically effective. The protocol was published on PROSPERO (ID number: CRD42023450373). <i>Results:</i> A comprehensive literature search yielded 925 articles and 11 studies meeting the inclusion criteria. The analysis showed a non-statistically significant reduction in mortality risk with tourniquet application (4.02% vs. 6.43%, RR 0.70, 95% CI 0.46–1.07). Analysis of outcomes of amputation of the traumatized limb indicated a statistically higher incidence of initial amputation in the tourniquet group (19.32% vs. 6.4%, RR 2.07, 95% CI 1.21–3.52), while delayed amputation showed no difference (9.39% vs. 3.66%, RR 0.93, 95% CI 0.42–2.07). Tourniquet use demonstrated a non-significant reduction in the number of blood components transfused (MD = −0.65; 95% CI −5.23 to 3.93 for pRBC, MD = −0.55; 95% CI −4.06 to 2.97 for plasma). <i>Conclusions:</i> Despite increasing use in civilian settings, this systematic review and meta-analysis showed no significant reduction in mortality or blood product use associated with prehospital tourniquet use. Further research, including high-quality randomized controlled trials, is required, as well as awareness and education campaigns relating to proper tourniquet use in the prehospital setting. |
| format | Article |
| id | doaj-art-e7badc63baaa4570a5eef6c71c313177 |
| institution | Kabale University |
| issn | 1010-660X 1648-9144 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj-art-e7badc63baaa4570a5eef6c71c3131772025-01-24T13:40:34ZengMDPI AGMedicina1010-660X1648-91442025-01-016119310.3390/medicina61010093Is the Use of Tourniquets More Advantageous than Other Bleeding Control Techniques in Patients with Limb Hemorrhage? A Systematic Review and Meta-AnalysisRoberto Cirocchi0Dominica Prigorschi1Luca Properzi2Matteo Matteucci3Francesca Duro4Giovanni Domenico Tebala5Bruno Cirillo6Paolo Sapienza7Gioia Brachini8Sara Lauricella9Diletta Cassini10Antonia Rizzuto11Andrea Mingoli12Department of Surgery, General Surgery, University of Perugia, 06123 Perugia, ItalyDepartment of Surgery, General Surgery, University of Perugia, 06123 Perugia, ItalyDepartment of Surgery, General Surgery, University of Perugia, 06123 Perugia, ItalyDepartment of Surgery, General Surgery, University of Milan, 20122 Milan, ItalyDepartment of Surgery, General Surgery, University of Perugia, 06123 Perugia, ItalyAzienda Ospedaliera S. Maria, 05100 Terni, ItalyDepartment of Surgery, General Surgery, Sapienza University of Rome, 00185 Roma, ItalyDepartment of Surgery, General Surgery, Sapienza University of Rome, 00185 Roma, ItalyDepartment of Surgery, General Surgery, Sapienza University of Rome, 00185 Roma, ItalyFondazione IRCCS Istituto Nazionale Dei Tumori, Department of Surgery, Colorectal Surgery Division, 20133 Milan, ItalyASST Nord Milano-Department of General and Rery, Sesto San Giovanni Hospital, 20099 Sesto San Giovanni, ItalyDepartment of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, ItalyDepartment of Surgery, General Surgery, Sapienza University of Rome, 00185 Roma, Italy<i>Background and Objectives:</i> Trauma, particularly uncontrolled bleeding, is a major cause of death. Recent evidence-based guidelines recommend the use of a tourniquet when life-threating limb bleeding cannot be controlled with direct pressure. Prehospital hemorrhage management, according to the XABCDE protocol, emphasizes the critical role of tourniquets in controlling massive bleeding. The aim of this systematic review and meta-analysis was to summarize data from the available scientific literature on the effectiveness of prehospital tourniquet use for extremity bleeding. <i>Materials and Methods:</i> A systematic review and meta-analysis was performed between March 2022 and March 2024, adhering to PRISMA guidelines, to determine whether prehospital tourniquets are clinically effective. The protocol was published on PROSPERO (ID number: CRD42023450373). <i>Results:</i> A comprehensive literature search yielded 925 articles and 11 studies meeting the inclusion criteria. The analysis showed a non-statistically significant reduction in mortality risk with tourniquet application (4.02% vs. 6.43%, RR 0.70, 95% CI 0.46–1.07). Analysis of outcomes of amputation of the traumatized limb indicated a statistically higher incidence of initial amputation in the tourniquet group (19.32% vs. 6.4%, RR 2.07, 95% CI 1.21–3.52), while delayed amputation showed no difference (9.39% vs. 3.66%, RR 0.93, 95% CI 0.42–2.07). Tourniquet use demonstrated a non-significant reduction in the number of blood components transfused (MD = −0.65; 95% CI −5.23 to 3.93 for pRBC, MD = −0.55; 95% CI −4.06 to 2.97 for plasma). <i>Conclusions:</i> Despite increasing use in civilian settings, this systematic review and meta-analysis showed no significant reduction in mortality or blood product use associated with prehospital tourniquet use. Further research, including high-quality randomized controlled trials, is required, as well as awareness and education campaigns relating to proper tourniquet use in the prehospital setting.https://www.mdpi.com/1648-9144/61/1/93tourniquettraumaamputationbleed |
| spellingShingle | Roberto Cirocchi Dominica Prigorschi Luca Properzi Matteo Matteucci Francesca Duro Giovanni Domenico Tebala Bruno Cirillo Paolo Sapienza Gioia Brachini Sara Lauricella Diletta Cassini Antonia Rizzuto Andrea Mingoli Is the Use of Tourniquets More Advantageous than Other Bleeding Control Techniques in Patients with Limb Hemorrhage? A Systematic Review and Meta-Analysis Medicina tourniquet trauma amputation bleed |
| title | Is the Use of Tourniquets More Advantageous than Other Bleeding Control Techniques in Patients with Limb Hemorrhage? A Systematic Review and Meta-Analysis |
| title_full | Is the Use of Tourniquets More Advantageous than Other Bleeding Control Techniques in Patients with Limb Hemorrhage? A Systematic Review and Meta-Analysis |
| title_fullStr | Is the Use of Tourniquets More Advantageous than Other Bleeding Control Techniques in Patients with Limb Hemorrhage? A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Is the Use of Tourniquets More Advantageous than Other Bleeding Control Techniques in Patients with Limb Hemorrhage? A Systematic Review and Meta-Analysis |
| title_short | Is the Use of Tourniquets More Advantageous than Other Bleeding Control Techniques in Patients with Limb Hemorrhage? A Systematic Review and Meta-Analysis |
| title_sort | is the use of tourniquets more advantageous than other bleeding control techniques in patients with limb hemorrhage a systematic review and meta analysis |
| topic | tourniquet trauma amputation bleed |
| url | https://www.mdpi.com/1648-9144/61/1/93 |
| work_keys_str_mv | AT robertocirocchi istheuseoftourniquetsmoreadvantageousthanotherbleedingcontroltechniquesinpatientswithlimbhemorrhageasystematicreviewandmetaanalysis AT dominicaprigorschi istheuseoftourniquetsmoreadvantageousthanotherbleedingcontroltechniquesinpatientswithlimbhemorrhageasystematicreviewandmetaanalysis AT lucaproperzi istheuseoftourniquetsmoreadvantageousthanotherbleedingcontroltechniquesinpatientswithlimbhemorrhageasystematicreviewandmetaanalysis AT matteomatteucci istheuseoftourniquetsmoreadvantageousthanotherbleedingcontroltechniquesinpatientswithlimbhemorrhageasystematicreviewandmetaanalysis AT francescaduro istheuseoftourniquetsmoreadvantageousthanotherbleedingcontroltechniquesinpatientswithlimbhemorrhageasystematicreviewandmetaanalysis AT giovannidomenicotebala istheuseoftourniquetsmoreadvantageousthanotherbleedingcontroltechniquesinpatientswithlimbhemorrhageasystematicreviewandmetaanalysis AT brunocirillo istheuseoftourniquetsmoreadvantageousthanotherbleedingcontroltechniquesinpatientswithlimbhemorrhageasystematicreviewandmetaanalysis AT paolosapienza istheuseoftourniquetsmoreadvantageousthanotherbleedingcontroltechniquesinpatientswithlimbhemorrhageasystematicreviewandmetaanalysis AT gioiabrachini istheuseoftourniquetsmoreadvantageousthanotherbleedingcontroltechniquesinpatientswithlimbhemorrhageasystematicreviewandmetaanalysis AT saralauricella istheuseoftourniquetsmoreadvantageousthanotherbleedingcontroltechniquesinpatientswithlimbhemorrhageasystematicreviewandmetaanalysis AT dilettacassini istheuseoftourniquetsmoreadvantageousthanotherbleedingcontroltechniquesinpatientswithlimbhemorrhageasystematicreviewandmetaanalysis AT antoniarizzuto istheuseoftourniquetsmoreadvantageousthanotherbleedingcontroltechniquesinpatientswithlimbhemorrhageasystematicreviewandmetaanalysis AT andreamingoli istheuseoftourniquetsmoreadvantageousthanotherbleedingcontroltechniquesinpatientswithlimbhemorrhageasystematicreviewandmetaanalysis |