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Liu N, Sun B, Xu J, Xu J, Zhao K, Xu S, Su X, Zhou W. Evaluation of blood evacuation efficiency using 99mTc-RBC imaging: a comparative study of exsanguination tourniquet rings and Esmarch bandages. Nucl Med Commun 2024:00006231-990000000-00330. [PMID: 39211998 DOI: 10.1097/mnm.0000000000001893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
OBJECTIVE The objective of this study is to compare the effectiveness of the Esmarch bandage and exsanguination tourniquet rings (ETRs) in blood evacuation procedures using a controlled intra-subject design involving healthy volunteers. METHODS A total of 20 healthy adult volunteers (12 males, 8 females) were recruited from the community. Participants underwent blood evacuation procedures on both legs, using the Esmarch bandage on one leg and the ETR on the other. The order of the procedures was randomized. Blood evacuation time, overall blood evacuation rate, and calf blood evacuation rate were measured using 99mTc-labeled red blood cell imaging. Paired t-tests were conducted to compare the effectiveness of the two methods. RESULTS The ETRs demonstrated a significantly faster blood evacuation time compared to the Esmarch bandage (mean difference = -41.72 s, P < 0.0001). The overall blood evacuation rate was slightly higher for the ETRs (mean difference = 1.717%), though not statistically significant (P = 0.3680). The calf blood evacuation rate was significantly higher for the ETRs (mean difference = 6.86%, P = 0.0225). No significant discomfort or adverse reactions were reported by any participants. CONCLUSION ETRs are more efficient in terms of blood evacuation time and calf blood evacuation rate compared to the Esmarch bandage, without causing significant discomfort or adverse reactions. These findings suggest that ETRs could be a preferable option in clinical settings for blood evacuation procedures.
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Affiliation(s)
- Ninghu Liu
- Department of Nuclear Medicine, the First Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China
| | - Binbin Sun
- Department of Orthopedics, Cixi People Hospital Medical Health Group (Cixi People Hospital), Zhejiang, China
| | - Jianjie Xu
- Department of Orthopedics, Cixi People Hospital Medical Health Group (Cixi People Hospital), Zhejiang, China
| | - Jianqiao Xu
- Department of Orthopedics, Cixi People Hospital Medical Health Group (Cixi People Hospital), Zhejiang, China
| | - Keqi Zhao
- Department of Orthopedics, Cixi People Hospital Medical Health Group (Cixi People Hospital), Zhejiang, China
| | - Shaonan Xu
- Department of Orthopedics, Cixi People Hospital Medical Health Group (Cixi People Hospital), Zhejiang, China
| | - Xinhui Su
- Department of Nuclear Medicine, the First Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China
| | - Weifeng Zhou
- Department of Orthopedics, Cixi People Hospital Medical Health Group (Cixi People Hospital), Zhejiang, China
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Xu J, Zhao K, Xu S, Xu J, Sun B, Tong S, Yao W, Bi Q, Yang Z, Zhou W. Comparison of exsanguination and hemostasis devices for Limb surgery: a multicenter randomized controlled study. BMC Musculoskelet Disord 2024; 25:679. [PMID: 39210304 PMCID: PMC11360307 DOI: 10.1186/s12891-024-07770-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 08/12/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Excessive intraoperative bleeding remains a challenge in limb surgeries. The exsanguination tourniquet ring has emerged as a potential solution for effective exsanguination and hemostasis. This study aims to evaluate its efficacy and safety compared to the conventional exsanguination and hemostasis approach (pneumatic tourniquet combined with Esmarch bandage). METHODS This randomized controlled trial evaluates the exsanguination tourniquet ring's effectiveness and safety versus the conventional approach in 220 participants undergoing various limb surgeries. Allocation included experimental and control groups, assesses through efficacy (including intraoperative and total blood loss, hemoglobin levels, and exsanguination and hemostasis effectiveness) and safety (adverse event occurrence) indicators. RESULTS The experimental group (n = 110) utilizes the exsanguination tourniquet ring, while the control group (n = 110) employs the conventional approach. As for intraoperative blood loss, the experimental group is non-inferior to the control group (p-value < 0.001). While no significant difference is found in total blood loss (for the full analysis set, p-value = 0.442; for the per protocol set, p-value = 0.976) and differences in postoperative and preoperative hemoglobin levels (for the full analysis set, p-value = 0.502; for the per protocol set, p-value = 0.928). Regarding exsanguination and hemostasis effectiveness, the full analysis set reveals significantly superior ratings in the experimental group compared to the control group (p-value = 0.002 < 0.05), while the per protocol set analysis indicates no significant difference between the groups (p-value = 0.504). As for safety indicators, adverse events related to the device are minimal in two groups, with only one severe event unrelated to the device. CONCLUSIONS The exsanguination tourniquet ring is an effective and safe device for intraoperative blood loss control in various limb surgeries. TRIAL REGISTRATION Comparison of Exsanguination and Hemostasis Devices for Limb Surgery A Prospective Multicenter Randomized Controlled Study, ChiCTR2300077998, 11/27/2023.
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Affiliation(s)
- Jianjie Xu
- Department of Orthopedics, Cixi People Hospital Medical Health Group (Cixi People Hospital), Zhejiang, 315300, China
| | - Keqi Zhao
- Department of Orthopedics, Cixi People Hospital Medical Health Group (Cixi People Hospital), Zhejiang, 315300, China
| | - Shaonan Xu
- Department of Orthopedics, Cixi People Hospital Medical Health Group (Cixi People Hospital), Zhejiang, 315300, China
| | - Jianqiao Xu
- Department of Orthopedics, Cixi People Hospital Medical Health Group (Cixi People Hospital), Zhejiang, 315300, China
| | - Binbin Sun
- Department of Orthopedics, Cixi People Hospital Medical Health Group (Cixi People Hospital), Zhejiang, 315300, China
| | - Songlin Tong
- Department of Orthopedics, Cixi People Hospital Medical Health Group (Cixi People Hospital), Zhejiang, 315300, China
| | - Wangxiang Yao
- Department of Orthopedics, Hangzhou First People's Hospital, Zhejiang University School of Medicine, Zhejiang, 310006, China.
| | - Qing Bi
- Department of Orthopedics, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, 310014, China.
| | - Zhengming Yang
- Department of Orthopedics, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Zhejiang, 310009, China.
| | - Weifeng Zhou
- Department of Orthopedics, Cixi People Hospital Medical Health Group (Cixi People Hospital), Zhejiang, 315300, China.
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Warner C, Peach C, Davies R. Widening Access: Sterile Tourniquets for Surgery to the Distal Humerus. Cureus 2023; 15:e46148. [PMID: 37900452 PMCID: PMC10613037 DOI: 10.7759/cureus.46148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 10/31/2023] Open
Abstract
Purpose of the study The use of tourniquets during surgery of the distal humerus can improve visibility and reduce surgical time. However, the available operating field can be limited due to the size and placement of the tourniquet. This proof-of-concept study aimed to determine if sterile tourniquets can provide a wider surgical field compared to non-sterile tourniquets for procedures around the distal humerus. Methods Volunteers (n = 5) were positioned to simulate access to the distal humerus. The distance from the posterior corner of the acromion to the tip of the olecranon was measured. Participants were draped according to the standard protocol for the use of a non-sterile or sterile tourniquet for distal humerus and humeral shaft fractures. Two non-sterile pneumatic tourniquets (standard and narrow) and two sterile tourniquets (pneumatic and elastic exsanguination) were tested. The surgical field was measured from the sterile drape or tourniquet proximally to the tip of the olecranon. A one-way repeated measures ANOVA was conducted to examine the effect of each tourniquet on the surgical field. Results The sterile elastic exsanguination tourniquet had the largest available field with a mean of 24.4 cm (71% of arm available for incision after application), followed by the sterile pneumatic tourniquet of 20.0 cm (58%), narrow non-sterile pneumatic of 19.2 cm (55%), and standard non-sterile pneumatic of 17.0 cm (49%). Repeated measures ANOVA determined that mean surgical field length is statistically significant between tourniquet devices (F (1.729, 6.914) = 21.783, p = .001). The surgical field length was statistically significantly increased from a non-sterile standard tourniquet to a sterile elastic tourniquet (7.4 (95% CI, 2.9-11.9) cm, p = .008) but not the other two tourniquet devices tested. Conclusion The use of certain types of sterile tourniquets can provide a wider surgical field compared to non-sterile tourniquets for procedures around the distal humerus, specifically the sterile elastic exsanguination tourniquet providing a statistically significant mean gain of 7.4 cm from the non-sterile tourniquets. These findings suggest that the use of sterile tourniquets should be considered more frequently in surgery of the distal humerus, and a sterile exsanguinating tourniquet could be considered for midshaft humeral fractures, facilitating safer exposure of the radial nerve and reduced blood loss.
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Affiliation(s)
- Christian Warner
- Trauma and Orthopaedics, Manchester Shoulder and Elbow Unit, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, GBR
| | - Christopher Peach
- Trauma and Orthopaedics, Manchester Shoulder and Elbow Unit, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, GBR
| | - Ronnie Davies
- Trauma and Orthopaedics, Manchester Shoulder and Elbow Unit, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, GBR
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Cordero JK, Lawrence KW, Brown AN, Li X, Hayden BL, Parisien RL. The Fragility of Tourniquet Use in Total Knee Arthroplasty: A Systematic Review of Randomized Controlled Trials. J Arthroplasty 2023; 38:1177-1183. [PMID: 36566999 DOI: 10.1016/j.arth.2022.12.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 12/17/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Physicians utilize P-values to interpret clinical trial data and guide patient-care decisions. Fragility analysis assesses the stability of statistical findings in relation to outcome event reversals. This study assessed the statistical fragility of recent randomized controlled trials (RCTs) investigating tourniquet use in total knee arthroplasty (TKA). METHODS We queried PubMed, EMBASE, and MEDLINE for RCTs comparing outcomes in TKA based on tourniquet use. Fragility index (FI) and reverse fragility index (reverse FI) were calculated - for significant and nonsignificant outcomes, respectively - as the number of outcome reversals required to change statistical significance. The fragility quotient (FQ) was calculated by dividing the FI or reverse FI by the sample size. Median overall FI and FQ were calculated for all included outcomes, and sub-analyses were performed by reported significance. The literature search yielded 23 studies reporting 91 total dichotomous outcomes. RESULTS Overall median FI was 4 with an interquartile range (IQR) of 3 to 6. Overall median FQ was 0.0476 (IQR 0.0291 to 0.0867). A total of 11 outcomes were statistically significant with a median FI and FQ of 2 (IQR 1.5 to 5) and 0.0200 (IQR 0.0148 to 0.0484), respectively. There were 80 outcomes that were nonsignificant with a median reverse FI of 4 (IQR 3 to 6). Loss to follow-up was greater than the median FI in 17.6% of outcomes. CONCLUSION Altering a small number of outcomes is often sufficient to reverse findings in RCTs evaluating tourniquet use in TKA. We recommend including fragility analyses to increase reliability in the interpretation of study conclusions.
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Affiliation(s)
- John K Cordero
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Ashley N Brown
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Xinning Li
- Boston University School of Medicine, Boston, Massachusetts
| | - Brett L Hayden
- Icahn School of Medicine at Mount Sinai, New York, New York
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Lee TS, Park KK, Cho BW, Lee WS, Kwon HM. Silicone ring tourniquet could be a substitute for a conventional tourniquet in total knee arthroplasty with a longer surgical field: a prospective comparative study in simultaneous total knee arthroplasty. BMC Musculoskelet Disord 2023; 24:363. [PMID: 37161363 PMCID: PMC10169314 DOI: 10.1186/s12891-023-06469-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 04/27/2023] [Indexed: 05/11/2023] Open
Abstract
INTRODUCTION This study aimed to compare the clinical outcomes of silicon ring tourniquets and conventional pneumatic tourniquets in total knee arthroplasty (TKA). The study compared the operation time, total bleeding amount, length from the tourniquet distal end to the patella superior pole (L_TP), and complications related to the two tourniquet application methods and attempted to determine whether the silicon ring tourniquet has advantages over conventional pneumatic tourniquets. MATERIALS AND METHODS This prospective comparative study included 30 patients who underwent bilateral simultaneous TKA for degenerative osteoarthritis in August to December 2021. All patients underwent TKA on one side with a conventional pneumatic tourniquet, while TKA on the other side with a silicon ring tourniquet. The primary outcomes were the L_TP, operation time, tourniquet time, total bleeding amount, total drainage amount, and postoperative visual analog scale (VAS) score of the tourniquet applied site at 6, 24, and 48 h postoperatively. The secondary outcome was tourniquet-related complications in both groups. RESULTS L_TP was significantly longer in the silicon ring tourniquet group compared with that in the pneumatic tourniquet group (20.22 ± 2.74 cm versus 15.12 ± 2.40, p < 0.001). No significant difference was found in other results. The tourniquet applied site pain was less in the silicon ring tourniquet group (p = 0.037). CONCLUSIONS Silicon ring tourniquet application resulted in better clinical outcomes than conventional pneumatic tourniquets in TKA. Because we can obtain a wider surgical field using silicon ring tourniquets without complications, silicon ring tourniquets could be a substitute for conventional pneumatic tourniquets in total knee arthroplasty or distal femoral surgeries.
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Affiliation(s)
- Tae Sung Lee
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Kwan Kyu Park
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Byung Woo Cho
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Woo-Suk Lee
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyuck Min Kwon
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
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