Is the Use of Tourniquets More Advantageous Than Other Bleeding Control Techniques in Patients with Limb Hemorrhage? A Systematic Review and Meta-Analysis

Overview

Journal Medicina (Kaunas)

Publisher MDPI

Date 2025 Jan 25

PMID 39859075

Authors

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

Affiliations

Soon will be listed here.

Abstract

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. 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). 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). 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.

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