1
|
Manteiga-Urbón JL, Martínez-Isasi S, Fernández-Méndez F, Otero-Agra M, Sanz-Arribas I, Barcala-Furelos M, Alonso-Calvete A, Barcala-Furelos R. Tourniquet application in time-critical aquatic emergencies on a moving rescue water craft (RWC): Can speed and precision coexist? Am J Emerg Med 2024; 82:161-165. [PMID: 38909551 DOI: 10.1016/j.ajem.2024.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/24/2024] [Accepted: 06/12/2024] [Indexed: 06/25/2024] Open
Abstract
Lifeguards are the first responders to any type of aquatic incident, including rapid rescue situations such as boating and sporting accidents, animal bites/attacks, and cases involving massive bleeding. In their line of work, rescue boats such as Rescue Water Craft (RWC) are commonly utilized the aim of this study is to evaluate the time and technique of placing a tourniquet on the sled of an RWC navigating at full speed. METHODS A randomized crossover study design was used with a sample of 44 lifeguards. The inclusion criteria required that participants be certified lifeguards with experience in RWC operations and possess knowledge of responding to massive bleeding. Two CAT tourniquet placement tests were performed. In the 1) Beach-Tourniquet (B-TQ) test: it was performed on land and in the 2) Rescue Water Craft-tourniquet (RWC-TQ) test, sailing at a cruising speed of 20 knots. The evaluation was recorded in a checklist on the steps and timing of the correct application TQ by direct observation by an expert instructor. RESULTS The tourniquet placement on RWC was an average of 11 s slower than when placed on the beach (BT-TQ 35.7 ± 8.0 vs. 46.1 ± 10.9 s, p > 0.001). In the percentage analysis of the results on correct execution of the skills, higher values are obtained for the B-TQ test than in RWC-TQ in Distance to the wound (into 5-7 cm), band adjustment, checking the radial pulse and reporting the time of tourniquet placement (p > 0.005). CONCLUSION The placement of a tourniquet on a RWC navigating at 20 knots is feasible, relatively quick, and technically well executed.
Collapse
Affiliation(s)
- J L Manteiga-Urbón
- REMOSS Research Group, International Drowning Research Alliance-IDRA (Spain), Faculty of Education and Sport Sciences, Universidade de Vigo, Spain
| | - S Martínez-Isasi
- CLINURSID Research Group, Psychiatry, Radiology, Public Health, Nursing and Medicine Department, Universidade de Santiago de Compostela, Santiago de Compostela, Spain; Simulation, Life Support, and Intensive Care Research Unit, (SICRUS) of the Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain; Faculty of Nursing, Universidade de Santiago de Compostela, Spain; Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS), Instituto de Salud Carlos III, RD21/0012/0025, Madrid, Spain
| | - F Fernández-Méndez
- REMOSS Research Group, International Drowning Research Alliance-IDRA (Spain), Faculty of Education and Sport Sciences, Universidade de Vigo, Spain; Escuela de Enfermería de Pontevedra, Universidade de Vigo, Pontevedra, Spain.
| | - M Otero-Agra
- REMOSS Research Group, International Drowning Research Alliance-IDRA (Spain), Faculty of Education and Sport Sciences, Universidade de Vigo, Spain; Escuela de Enfermería de Pontevedra, Universidade de Vigo, Pontevedra, Spain
| | - I Sanz-Arribas
- Departamento de Educación Física, Deporte y Motricidad Humana de la Facultad de Formación de Profesorado y Educación, Universidad Autónoma de Madrid, Madrid, Spain
| | - M Barcala-Furelos
- Faculty of Health Sciences, Universidad Europa del Atlántico, Santander, Spain
| | - A Alonso-Calvete
- REMOSS Research Group, International Drowning Research Alliance-IDRA (Spain), Faculty of Education and Sport Sciences, Universidade de Vigo, Spain; Facultad de Fisioterapia, Universidad de Vigo
| | - R Barcala-Furelos
- REMOSS Research Group, International Drowning Research Alliance-IDRA (Spain), Faculty of Education and Sport Sciences, Universidade de Vigo, Spain; Simulation, Life Support, and Intensive Care Research Unit, (SICRUS) of the Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| |
Collapse
|
2
|
Barcala Furelos R, Schmidt A, Manteiga Urbón J, Aranda García S, Otero-Agra M, di Tullio N, de Oliveira J, Martínez Isasi S, Fernández-Méndez F. Aquatic Feasibility of Limbs Application of Tourniquets (AFLAT) during a Lifeguard Water Rescue: A Simulation Pilot Study. Prehosp Disaster Med 2024; 39:52-58. [PMID: 38328881 DOI: 10.1017/s1049023x24000050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
INTRODUCTION Control of massive hemorrhage (MH) is a life-saving intervention. The use of tourniquets has been studied in prehospital and battlefield settings but not in aquatic environments. OBJECTIVE The aim of this research is to assess the control of MH in an aquatic environment by analyzing the usability of two tourniquet models with different adjustment mechanisms: windlass rod versus ratchet. METHODOLOGY A pilot simulation study was conducted using a randomized crossover design to assess the control of MH resulting from an upper extremity arterial perforation in an aquatic setting. A sample of 24 trained lifeguards performed two randomized tests: one using a windlass-based Combat Application Tourniquet 7 Gen (T-CAT) and the other using a ratchet-based OMNA Marine Tourniquet (T-OMNA) specifically designed for aquatic use on a training arm for hemorrhage control. The tests were conducted after swimming an approximate distance of 100 meters and the tourniquets were applied while in the water. The following parameters were recorded: time of rescue (rescue phases and tourniquet application), perceived fatigue, and technical actions related to tourniquet skills. RESULTS With the T-OMNA, 46% of the lifeguards successfully stopped the MH compared to 21% with the T-CAT (P = .015). The approach swim time was 135 seconds with the T-OMNA and 131 seconds with the T-CAT (P = .42). The total time (swim time plus tourniquet placement) was 174 seconds with the T-OMNA and 177 seconds with the T-CAT (P = .55). The adjustment time (from securing the Velcro to completing the manipulation of the windlass or ratchet) for the T-OMNA was faster than with the T-CAT (six seconds versus 19 seconds; P < .001; effect size [ES] = 0.83). The perceived fatigue was high, with a score of seven out of ten in both tests (P = .46). CONCLUSIONS Lifeguards in this study demonstrated the ability to use both tourniquets during aquatic rescues under conditions of fatigue. The tourniquet with the ratcheting-fixation system controlled hemorrhage in less time than the windlass rod-based tourniquet, although achieving complete bleeding control had a low success rate.
Collapse
Affiliation(s)
- Roberto Barcala Furelos
- REMOSS Research Group, Facultade de CC. da Educación e do Deporte, Universidade de Vigo, Pontevedra, Spain
- Simulation and Intensive Care Unit of Santiago (SICRUS) Research Group, Health Research Institute of Santiago, University Hospital of Santiago de Compostela-CHUS, Santiago de Compostela, Spain
| | - Andrew Schmidt
- Department of Emergency Medicine, University of Florida-Jacksonville, Jacksonville, FloridaUSA
| | - José Manteiga Urbón
- REMOSS Research Group, Facultade de CC. da Educación e do Deporte, Universidade de Vigo, Pontevedra, Spain
| | - Silvia Aranda García
- GRAFAIS Research Group, Institut Nacional d'Educació Física de Catalunya (INEFC), University of Barcelona, Barcelona, Spain
- CLINURSID Research Group, Psychiatry, Radiology, Public Health, Nursing and Medicine Department, Universidade de Santiago de Compostela, Santiago de Compostela, Spain, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Martín Otero-Agra
- REMOSS Research Group, Facultade de CC. da Educación e do Deporte, Universidade de Vigo, Pontevedra, Spain
- School of Nursing, Universidade de Vigo, Pontevedra, Spain
| | - Nicolò di Tullio
- Sant'Anna School of Advanced Studies, Institute of Management, Piazza Martiri della Libertà, Pisa, Italy
| | - Joel de Oliveira
- REMOSS Research Group, Facultade de CC. da Educación e do Deporte, Universidade de Vigo, Pontevedra, Spain
- Surfing Medicine International, the Netherlands
| | - Santiago Martínez Isasi
- Simulation and Intensive Care Unit of Santiago (SICRUS) Research Group, Health Research Institute of Santiago, University Hospital of Santiago de Compostela-CHUS, Santiago de Compostela, Spain
- CLINURSID Research Group, Psychiatry, Radiology, Public Health, Nursing and Medicine Department, Universidade de Santiago de Compostela, Santiago de Compostela, Spain, University of Santiago de Compostela, Santiago de Compostela, Spain
- Faculty of Nursing, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Felipe Fernández-Méndez
- REMOSS Research Group, Facultade de CC. da Educación e do Deporte, Universidade de Vigo, Pontevedra, Spain
- School of Nursing, Universidade de Vigo, Pontevedra, Spain
| |
Collapse
|
3
|
Thai AP, Tseng ES, Kishawi SK, Robenstine JC, Ho VP. Prehospital tourniquet application in extremity vascular trauma: Improved functional outcomes. Surgery 2023; 174:1471-1475. [PMID: 37735036 PMCID: PMC11334707 DOI: 10.1016/j.surg.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/21/2023] [Accepted: 08/08/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Support for prehospital tourniquet use has increased, with recent data suggesting that tourniquet usage decreases shock without increasing limb complications. We hypothesized that prehospital tourniquet application in extremity vascular trauma, compared with no prehospital tourniquet application, is associated with lower rates of delayed amputation and better functional mobility. METHODS We retrospectively studied adult patients with extremity vascular trauma at an urban civilian Level 1 trauma center (June 2016-May 2021). Outcomes of interest included delayed amputation and mobility at hospital discharge, measured by the Activity Measure for Post-Acute Care "6 Clicks" Basic Mobility Score. The "6 Clicks" Basic Mobility Score was documented by physical therapy; higher scores indicate more independent mobility. Injury mechanism, initial lactate, 24-hour transfusions, mortality, and acute kidney injury were also collected. Comparisons were performed using χ2 analysis and Fisher Exact and Wilcoxon rank-sum tests. RESULTS Of 232 patients, prehospital tourniquet application was not associated with mortality or lactate level (both P > .05). The prehospital tourniquet application group had more transfusions, lower rates of acute kidney injury, and fewer delayed amputations (all P < .05). Ninety-one patients (45 prehospital tourniquet application and 46 without prehospital tourniquet application) were evaluated for "Moving between Bed and Chair" in the "6 Clicks" Basic Mobility Score, with patients in the prehospital tourniquet application group demonstrating higher levels of independence (P = .034). CONCLUSION Prehospital tourniquet application was associated with favorable outcomes, including higher functional mobility and decreased delayed amputation. This suggests that tourniquet use should be encouraged in the civilian setting to improve outcomes and reduce the risk of limb loss.
Collapse
Affiliation(s)
- Anthony P Thai
- Case Western Reserve University, School of Medicine, Cleveland, OH
| | - Esther S Tseng
- Case Western Reserve University, School of Medicine, Cleveland, OH; Division of Trauma Surgery, Acute Care Surgery, Critical Care, and Burns, Department of Surgery, MetroHealth Medical Center, Cleveland, OH
| | - Sami K Kishawi
- Case Western Reserve University, School of Medicine, Cleveland, OH; Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Jacinta C Robenstine
- Case Western Reserve University, School of Medicine, Cleveland, OH; Division of Trauma Surgery, Acute Care Surgery, Critical Care, and Burns, Department of Surgery, MetroHealth Medical Center, Cleveland, OH
| | - Vanessa P Ho
- Case Western Reserve University, School of Medicine, Cleveland, OH; Division of Trauma Surgery, Acute Care Surgery, Critical Care, and Burns, Department of Surgery, MetroHealth Medical Center, Cleveland, OH; Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH.
| |
Collapse
|
4
|
Manteiga-Urbón JL, Fernández-Méndez F, Otero-Agra M, Fernández-Méndez M, Santos-Folgar M, Insa-Calderon E, Sobrido-Prieto M, Barcala-Furelos R, Martínez-Isasi S. Brief Training of Technical Bleeding Control Skills-A Pilot Study with Security Forces. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2494. [PMID: 36767862 PMCID: PMC9915853 DOI: 10.3390/ijerph20032494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/17/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
Uncontrolled external bleeding is a common cause of preventable death, and due to the environment in which these events often occur, e.g., in hostile environments, the state security forces are usually the first responders, and in many cases, if they are injured their partners provide the initial assistance. The tourniquet is a fast, effective, and easy-to-learn intervention, although there is a knowledge gap concerning training techniques. The objective is to evaluate the effectiveness of a bleeding control training program on a high-fidelity mannequin in a simulated critical situation in a law enforcement training environment. A quasi-experimental study was carried out with 27 members of the state security forces. They underwent brief theoretical-practical training and were evaluated via a scenario involving a critically ill patient in a hostile environment. The results showed that no member of the state security forces completed all the tourniquet placement steps, 26 (96%) prepared the tourniquet correctly, 21 (77.8%) placed it on the leg, and all the participants adjusted the band to the thickness of the injured limb and secured the windlass to the triangular flange of the device. However, only 23 (85.2%) of the participants placed it effectively. The participants, who were members of the state security forces, were able to effectively resolve a critical situation with active bleeding in a simulation scenario with a high-fidelity mannequin after completing theoretical-practical training.
Collapse
Affiliation(s)
| | - Felipe Fernández-Méndez
- REMOSS Research Group, University of Vigo, 36005 Pontevedra, Spain
- School of Nursing, University of Vigo, 36005 Pontevedra, Spain
| | - Martín Otero-Agra
- REMOSS Research Group, University of Vigo, 36005 Pontevedra, Spain
- School of Nursing, University of Vigo, 36005 Pontevedra, Spain
| | - María Fernández-Méndez
- REMOSS Research Group, University of Vigo, 36005 Pontevedra, Spain
- School of Nursing, University of Vigo, 36005 Pontevedra, Spain
| | - Myriam Santos-Folgar
- REMOSS Research Group, University of Vigo, 36005 Pontevedra, Spain
- School of Nursing, University of Vigo, 36005 Pontevedra, Spain
| | - Esther Insa-Calderon
- ESIMar (Mar Nursing School), Parc de Salut Mar, Universitat Pompeu Fabra Affiliated, 08003 Barcelona, Spain
- SDHEd (Social Determinants and Health Education Research Group), IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
| | - María Sobrido-Prieto
- Departamento de Ciencias da Saúde, Universidade de A Coruña (UDC), Campus de Esteiro, 15403 Ferrol, Spain
| | - Roberto Barcala-Furelos
- REMOSS Research Group, University of Vigo, 36005 Pontevedra, Spain
- Simulation and Intensive Care Unit of Santiago (SICRUS) Research Group, Health Research Institute of Santiago, University Hospital of Santiago de Compostela-CHUS, 15706 Santiago Compostela, Spain
- Faculty of Education and Sport Sciences, University of Vigo, 36005 Pontevedra, Spain
| | - Santiago Martínez-Isasi
- Simulation and Intensive Care Unit of Santiago (SICRUS) Research Group, Health Research Institute of Santiago, University Hospital of Santiago de Compostela-CHUS, 15706 Santiago Compostela, Spain
- CLINURSID Research Group, Psychiatry, Radiology, Public Health, Nursing and Medicine Department, Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain
- Faculty of Nursing, Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain
| |
Collapse
|
5
|
Gavriely RP, Lior Y, Gelikas S, Levy S, Ahimor A, Glassberg E, Shapira S, Benov A, Avital G. Manual Pressure Points Technique for Massive Hemorrhage Control - A Prospective Human Volunteer Study. PREHOSP EMERG CARE 2022:1-6. [PMID: 36074122 DOI: 10.1080/10903127.2022.2122644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND While commonly thought to be effective for management of limb and junctional hemorrhage, the manual pressure points technique was excluded from leading prehospital guidelines over a decade ago following the publication of a single human-volunteers study presenting unfavorable results. This work aimed to re-assess the efficacy and feasibility of the femoral and supraclavicular pressure points technique for temporary hemorrhage control distal to the pressure point. METHODS A prospective, non-randomized, human volunteer, controlled environment study. In the study 35 healthy male combat medics (age 21.1 ± 1.3 years) received brief training after which they were requested to apply pressure in the femoral and supraclavicular points in attempts to stop regional blood flow, measured distally by Doppler ultrasound. Success rates in achieving flow cessation in under 2 minutes, time required for achievement of flow cessation, and cumulative flow cessation duration within a 3-minute follow-up after initial success were measured. RESULTS For the supraclavicular point, success rates were 97.1% with a mean time to success of 12.5 (±20.9) seconds, lasting for 76.2% (±23.7) of the follow-up time. For the femoral point, success rates were 100% with a mean time to success of 5.5 (±4.3) seconds, lasting for 98.7% (±3.8) of the follow-up time. CONCLUSIONS Manual pressure on the femoral and supraclavicular points is an applicable and efficient method for temporary hemorrhage control distal to the pressure point. As such, with additional study, this method may be considered for re-introduction to prehospital care guidelines and training programs.
Collapse
Affiliation(s)
- Regina Pikman Gavriely
- Israel Defense Forces Medical Corps, Ramat Gan, Israel.,Division of Anesthesia, Intensive Care, and Pain Management, Tel-Aviv Medical Center, Tel-Aviv, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yotam Lior
- Division of Anesthesia, Intensive Care, and Pain Management, Tel-Aviv Medical Center, Tel-Aviv, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shaul Gelikas
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Shiran Levy
- Israel Defense Forces Medical Corps, Ramat Gan, Israel.,Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Alon Ahimor
- Israel Defense Forces Medical Corps, Ramat Gan, Israel.,Department of Ophthalmology, Shamir Medical Center, Zrifin, Israel
| | - Elon Glassberg
- Israel Defense Forces Medical Corps, Ramat Gan, Israel.,The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.,Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Shachar Shapira
- Israel Defense Forces Medical Corps, Ramat Gan, Israel.,Department of Military Medicine, Hebrew University of Jerusalem
| | - Avi Benov
- Israel Defense Forces Medical Corps, Ramat Gan, Israel.,The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Guy Avital
- Israel Defense Forces Medical Corps, Ramat Gan, Israel.,Division of Anesthesia, Intensive Care, and Pain Management, Tel-Aviv Medical Center, Tel-Aviv, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
6
|
Day A. ENA Position Statement: Hemorrhage Control. J Emerg Nurs 2022; 48:460-464. [PMID: 35787775 DOI: 10.1016/j.jen.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/15/2022] [Accepted: 03/11/2022] [Indexed: 11/19/2022]
|
7
|
Llompart-Pou JA, Chico-Fernández M. Traumatic critical hemorrhage. Future challenges. Med Intensiva 2022; 46:217-220. [PMID: 35210173 DOI: 10.1016/j.medine.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/12/2021] [Accepted: 04/15/2021] [Indexed: 06/14/2023]
Affiliation(s)
- J A Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma, Balearic Islands, Spain.
| | - M Chico-Fernández
- Unidad de Cuidados Intensivos de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Spain
| |
Collapse
|
8
|
Latina R, Iacorossi L, Fauci AJ, Biffi A, Castellini G, Coclite D, D’Angelo D, Gianola S, Mari V, Napoletano A, Porcu G, Ruggeri M, Iannone P, Chiara O. Effectiveness of Pre-Hospital Tourniquet in Emergency Patients with Major Trauma and Uncontrolled Haemorrhage: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12861. [PMID: 34886586 PMCID: PMC8657739 DOI: 10.3390/ijerph182312861] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/25/2021] [Accepted: 11/26/2021] [Indexed: 11/26/2022]
Abstract
Trauma is one of the leading causes of uncontrolled haemorrhage, death, and disability. Use of a tourniquet can be considered an optimal anti-haemorrhagic resource, in pre-hospital and emergency settings, and its lifesaving effect is clinically contradictory. This review aims to assess the clinical efficacy of the tourniquet in the emergency pre-hospital care setting for the management of haemorrhage. We conducted the systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, the PRISMA statement. We searched the following electronic databases: EMBASE, MEDLINE, and Cochrane-CENTRAL. All studies included were appraised for risk of bias. Prevalent primary outcomes were mortality and use of blood products. Secondary outcomes were related to adverse effects. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach (GRADE). Four studies were involved (1762 trauma patients). The adjusted odds ratio (aOR) of 0.47 (95% confidence Interval (CI) 0.19-1.16; three studies; 377 patients) for overall mortality estimates did not give a clear indication of the benefits of emergency pre-hospital tourniquets (PH-TQ) versus no pre-hospital tourniquet (NO PH-TQ) placement. The adjusted mean difference for blood product use was -3.28 (95% CI -11.22, 4.66) for packed red blood cells (pRBC) and -4.80 (95% CI -5.61, -3.99) for plasma, respectively. The certainty of evidence was downgraded to very low for all outcomes. Our results suggest an unclear effect of emergency pre-hospital tourniquet placement on overall mortality and blood product use. However, this systematic review highlights the availability of only observational studies and the absence of high quality RCTs assessing the efficacy of PH-TQs. Randomized controlled trials are needed.
Collapse
Affiliation(s)
- Roberto Latina
- National Centre for Clinical Excellence Healthcare Quality and Safety, Istituto Superiore di Sanità, Via Giano della Bella 34, 00162 Rome, Italy; (R.L.); (L.I.); (A.J.F.); (D.C.); (D.D.); (V.M.); (P.I.)
- Department of Health Promotion Science, Maternal and Infant Care, Internal Medicine and Medical Specialities, University of Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy
| | - Laura Iacorossi
- National Centre for Clinical Excellence Healthcare Quality and Safety, Istituto Superiore di Sanità, Via Giano della Bella 34, 00162 Rome, Italy; (R.L.); (L.I.); (A.J.F.); (D.C.); (D.D.); (V.M.); (P.I.)
- IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Roma, Italy
| | - Alice Josephine Fauci
- National Centre for Clinical Excellence Healthcare Quality and Safety, Istituto Superiore di Sanità, Via Giano della Bella 34, 00162 Rome, Italy; (R.L.); (L.I.); (A.J.F.); (D.C.); (D.D.); (V.M.); (P.I.)
| | - Annalisa Biffi
- Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milan, Italy; (A.B.); (G.P.)
| | - Greta Castellini
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy; (G.C.); (S.G.)
| | - Daniela Coclite
- National Centre for Clinical Excellence Healthcare Quality and Safety, Istituto Superiore di Sanità, Via Giano della Bella 34, 00162 Rome, Italy; (R.L.); (L.I.); (A.J.F.); (D.C.); (D.D.); (V.M.); (P.I.)
| | - Daniela D’Angelo
- National Centre for Clinical Excellence Healthcare Quality and Safety, Istituto Superiore di Sanità, Via Giano della Bella 34, 00162 Rome, Italy; (R.L.); (L.I.); (A.J.F.); (D.C.); (D.D.); (V.M.); (P.I.)
| | - Silvia Gianola
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy; (G.C.); (S.G.)
| | - Veronica Mari
- National Centre for Clinical Excellence Healthcare Quality and Safety, Istituto Superiore di Sanità, Via Giano della Bella 34, 00162 Rome, Italy; (R.L.); (L.I.); (A.J.F.); (D.C.); (D.D.); (V.M.); (P.I.)
| | - Antonello Napoletano
- National Centre for Clinical Excellence Healthcare Quality and Safety, Istituto Superiore di Sanità, Via Giano della Bella 34, 00162 Rome, Italy; (R.L.); (L.I.); (A.J.F.); (D.C.); (D.D.); (V.M.); (P.I.)
| | - Gloria Porcu
- Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milan, Italy; (A.B.); (G.P.)
| | - Matteo Ruggeri
- National Centre for Health Technology Assessment, Istituto Superiore di Sanità, Via Giano della Bella 34, 00162 Rome, Italy;
| | - Primiano Iannone
- National Centre for Clinical Excellence Healthcare Quality and Safety, Istituto Superiore di Sanità, Via Giano della Bella 34, 00162 Rome, Italy; (R.L.); (L.I.); (A.J.F.); (D.C.); (D.D.); (V.M.); (P.I.)
| | - Osvaldo Chiara
- General Surgery and Trauma Team, ASST Grande Ospedale Metropolitano Niguarda, University of Milan, Piazza Ospedale Maggiore 3, 20162 Milan, Italy;
| | | |
Collapse
|
9
|
Preparation of a Cage-Type Polyglycolic Acid/Collagen Nanofiber Blend with Improved Surface Wettability and Handling Properties for Potential Biomedical Applications. Polymers (Basel) 2021; 13:polym13203458. [PMID: 34685218 PMCID: PMC8541674 DOI: 10.3390/polym13203458] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 09/30/2021] [Accepted: 10/05/2021] [Indexed: 11/17/2022] Open
Abstract
Electrospun biobased polymeric nanofiber blends are widely used as biomaterials for different applications, such as tissue engineering and cell adhesion; however, their surface wettability and handling require further improvements for their practical utilization in the assistance of surgical operations. Therefore, Polyglycolic acid (PGA) and collagen-based nanofibers with three different ratios (40:60, 50:50 and 60:40) were prepared using the electrospinning method, and their surface wettability was improved using ozonation and plasma (nitrogen) treatment. The effect on the wettability and the morphology of pristine and blended PGA and collagen nanofibers was assessed using the WCA test and SEM, respectively. It was observed that PGA/collagen with the ratio 60:40 was the optimal blend, which resulted in nanofibers with easy handling and bead-free morphology that could maintain their structural integrity even after the surface treatments, imparting hydrophilicity on the surface, which can be advantageous for cell adhesion applications. Additionally, a cage-type collector was used during the electrospinning process to provide better handling properties to (PGA/collagen 60:40) blend. The resultant nanofiber mat was then incorporated with activated poly (α,β-malic acid) to improve its surface hydrophilicity. The chemical composition of PGA/collagen 60:40 was assessed using FTIR spectroscopy, supported by Raman spectroscopy.
Collapse
|
10
|
Charlton N, Schuler K, Ho CH, Hatten J, Woods WA, Goolsby C. Provider Fatigue During Direct Manual Compression for Life-Threatening Bleeding. Cureus 2021; 13:e17487. [PMID: 34603872 PMCID: PMC8476202 DOI: 10.7759/cureus.17487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Trauma is a leading cause of death throughout the world, with hemorrhage being responsible for more than 35% of pre-hospital trauma deaths and more than 40% of deaths within the first 24 hours after injury. Despite first aid having a demonstrable effect on mortality from trauma, relatively little research has compared the best methods for bleeding control in the prehospital first aid setting. The most common first-line therapy for external bleeding control in the pre-hospital first aid setting is direct manual compression (DMC). However, a prior study demonstrated that the primary cause of failure in a simulated model of life-threatening bleeding was the inability to maintain adequate direct pressure for three minutes. In this study, we evaluated the effect of fatigue on DMC for the duration of a typical urban emergency medical services (EMS) response time. Methods We conducted a prospective observational trial of 33 participants, 18 years of age or older to measure the pressure generated on a model of life-threatening bleeding over an eight-minute period using a “CPR posture” for applying pressure. The primary analyses were longitudinal two-level multilevel models (MLM) with repeated measures of outcome (i.e., CPR posture pressure) nesting within participants. The demographic factors of gender, age, and weight were included as moderators in the analyses and each was analyzed independently. Results The participants’ average age was 31 (SD = 11) and the average weight was 161 pounds (SD = 31). The sample consisted of 18 female participants (54.5%) and 15 male participants (45.5%). Applied DMC pressure declined over time, more sharply initially from the beginning to approximately 250 seconds, at which point the decrease in pressure was gradual. Of the demographic factors, gender was associated with a difference in cardiopulmonary resuscitation (CPR) posture pressure over time. Conclusion Rescuers should be aware that fatigue may occur and may affect the quality of direct manual compression for control of life-threatening bleeding. Further research is needed to define the external pressures needed to control life-threatening bleeding and the extent that rescuer fatigue affects this pressure.
Collapse
Affiliation(s)
- Nathan Charlton
- Emergency Medicine, University of Virginia, Charlottesville, USA
| | - Keke Schuler
- Emergency Medicine, National Center for Disaster Medicine and Public Health, Bethesda, USA
| | - Chi H Ho
- Public Health Sciences, University of Virginia, Charlottesville, USA
| | - James Hatten
- Emergency Medicine, University of Virginia, Charlottesville, USA
| | - William A Woods
- Emergency Medicine, University of Virginia, Charlottesville, USA
| | - Craig Goolsby
- Military & Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, USA
| |
Collapse
|
11
|
Llompart-Pou JA, Chico-Fernández M. Traumatic critical hemorrhage. Future challenges. Med Intensiva 2021; 46:S0210-5691(21)00080-2. [PMID: 34074566 DOI: 10.1016/j.medin.2021.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/12/2021] [Accepted: 04/15/2021] [Indexed: 11/30/2022]
Affiliation(s)
- J A Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma, Baleares, España.
| | - M Chico-Fernández
- Unidad de Cuidados Intensivos de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España
| |
Collapse
|
12
|
Increased Use of Prehospital Tourniquet and Patient Survival: Los Angeles Countywide Study. J Am Coll Surg 2021; 233:233-239.e2. [PMID: 33895335 DOI: 10.1016/j.jamcollsurg.2021.03.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/08/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Recent trends in prehospital tourniquet use remain underreported. In addition, the impact of prehospital tourniquet use on patient survival has not been evaluated in a population-level study. We hypothesized that prehospital tourniquets were used more frequently in Los Angeles County and their use was associated with improved patient survival. STUDY DESIGN This is a retrospective cohort study using a database maintained by the Los Angeles County Emergency Medical Services Agency. We included patients who sustained extremity vascular injuries between October 2015 and July 2019. Patients were divided into the following study groups: prehospital tourniquet and no-tourniquet group. Our primary end point was in-hospital mortality. The secondary outcomes included 4- and 24-hour transfusion requirements and delayed amputation. RESULTS A total of 944 patients met our inclusion criteria. Of those, 97 patients (10.3%) had prehospital tourniquets placed. The rate of tourniquet use increased linearly throughout our study period (goodness of fit, p = 0.014). In multivariable analysis, prehospital tourniquet use was significantly associated with improved mortality (adjusted odds ratio 0.32; 95% CI, 0.16 to 0.85; p = 0.032). Similarly, transfusion requirements were significantly lower within 4 hours (regression coefficient -547.76; 95% CI, -762.73 to -283.49; p < 0.001) and 24 hours (regression coefficient -1,389.82; 95% CI, -1,824.88 to -920.97; p < 0.001). There was no significant difference in delayed amputation rates (adjusted odds ratio 1.07; 95% CI, 0.21 to 10.88; p < 0.097). CONCLUSIONS Prehospital tourniquet use has been on the rise in Los Angeles County. Our results suggest that the use of prehospital tourniquets for extremity vascular injuries is associated with improved patient survival and decreased blood transfusion requirements, without an increase in delayed amputations.
Collapse
|
13
|
Charlton NP, Goolsby CA, Zideman DA, Maconochie IK, Morley PT, Singletary EM. Appropriate Tourniquet Types in the Pediatric Population: A Systematic Review. Cureus 2021; 13:e14474. [PMID: 33996333 PMCID: PMC8118807 DOI: 10.7759/cureus.14474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/11/2021] [Indexed: 11/29/2022] Open
Abstract
Trauma is the leading cause of mortality in those aged 1-19, with hemorrhage accounting for up to 40% of all trauma deaths. Manufactured tourniquets are recommended for the control of life-threatening extremity hemorrhage in adults but their use in the pediatric population requires further investigation. We performed a systematic review to evaluate the most appropriate tourniquet design for use in the pediatric population. A literature search of Embase and the Cochran databases of trials and systematic reviews on October 1, 2020 identified 454 unique references, of which 15 were included for full-text screening. Two single-arm observational studies with a high risk of bias evaluated the use of windlass tourniquets in the pediatric population (73 patients, age 2-16 years). The certainty of the evidence was very low. In both studies, conducted on uninjured extremities, the use of a manufactured windlass tourniquet, specifically the Combat Application Tourniquet (C-A-T®) Generation 7, led to the cessation of Doppler detected pulses in 71/71 (100%) of upper extremities and 69/73 (94.5%) of lower extremities. Of the four failures, one participant withdrew due to pain and three tourniquet applications failed to occlude pulses after three turns of the windlass. No controls were used for comparison. In conclusion, two observational studies demonstrated that windlass tourniquets were able to abolish distal pulses in children as young as two years of age and with a minimum limb circumference of 13 cm. These preliminary findings may be helpful for organizations in the creation of guidelines for the management of life-threatening extremity bleeding in children.
Collapse
Affiliation(s)
| | - Craig A Goolsby
- Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, USA
| | - David A Zideman
- Pre-Hospital Emergency Medicine, Thames Valley Air Ambulance, Oxford, GBR
| | - Ian K Maconochie
- Pediatric Emergency Medicine, Imperial College London, London, GBR
| | - Peter T Morley
- Intensive Care Unit, The Royal Melbourne Hospital, Melborne, AUS
| | | |
Collapse
|
14
|
Nolan JP, Maconochie I, Soar J, Olasveengen TM, Greif R, Wyckoff MH, Singletary EM, Aickin R, Berg KM, Mancini ME, Bhanji F, Wyllie J, Zideman D, Neumar RW, Perkins GD, Castrén M, Morley PT, Montgomery WH, Nadkarni VM, Billi JE, Merchant RM, de Caen A, Escalante-Kanashiro R, Kloeck D, Wang TL, Hazinski MF. Executive Summary: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2020; 142:S2-S27. [PMID: 33084397 DOI: 10.1161/cir.0000000000000890] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
15
|
Singletary EM, Zideman DA, Bendall JC, Berry DA, Borra V, Carlson JN, Cassan P, Chang WT, Charlton NP, Djärv T, Douma MJ, Epstein JL, Hood NA, Markenson DS, Meyran D, Orkin A, Sakamoto T, Swain JM, Woodin JA, De Buck E, De Brier N, O D, Picard C, Goolsby C, Oliver E, Klaassen B, Poole K, Aves T, Lin S, Handley AJ, Jensen J, Allan KS, Lee CC. 2020 International Consensus on First Aid Science With Treatment Recommendations. Resuscitation 2020; 156:A240-A282. [PMID: 33098920 DOI: 10.1016/j.resuscitation.2020.09.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This is the summary publication of the International Liaison Committee on Resuscitation's 2020 International Consensus on First Aid Science With Treatment Recommendations. It addresses the most recent published evidence reviewed by the First Aid Task Force science experts. This summary addresses the topics of first aid methods of glucose administration for hypoglycemia; techniques for cooling of exertional hyperthermia and heatstroke; recognition of acute stroke; the use of supplementary oxygen in acute stroke; early or first aid use of aspirin for chest pain; control of life- threatening bleeding through the use of tourniquets, haemostatic dressings, direct pressure, or pressure devices; the use of a compression wrap for closed extremity joint injuries; and temporary storage of an avulsed tooth. Additional summaries of scoping reviews are presented for the use of a recovery position, recognition of a concussion, and 6 other first aid topics. The First Aid Task Force has assessed, discussed, and debated the certainty of evidence on the basis of Grading of Recommendations, Assessment, Development, and Evaluation criteria and present their consensus treatment recommendations with evidence-to-decision highlights and identified priority knowledge gaps for future research. The 2020 International Consensus on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) Science With Treatment Recommendations (CoSTR) is the fourth in a series of annual summary publications from the International Liaison Committee on Resuscitation (ILCOR). This 2020 CoSTR for first aid includes new topics addressed by systematic reviews performed within the past 12 months. It also includes updates of the first aid treatment recommendations published from 2010 through 2019 that are based on additional evidence evaluations and updates. As a result, this 2020 CoSTR for first aid represents the most comprehensive update since 2010.
Collapse
|
16
|
Nolan JP, Maconochie I, Soar J, Olasveengen TM, Greif R, Wyckoff MH, Singletary EM, Aickin R, Berg KM, Mancini ME, Bhanji F, Wyllie J, Zideman D, Neumar RW, Perkins GD, Castrén M, Morley PT, Montgomery WH, Nadkarni VM, Billi JE, Merchant RM, de Caen A, Escalante-Kanashiro R, Kloeck D, Wang TL, Hazinski MF. Executive Summary 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation 2020; 156:A1-A22. [PMID: 33098915 PMCID: PMC7576314 DOI: 10.1016/j.resuscitation.2020.09.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
17
|
Singletary EM, Zideman DA, Bendall JC, Berry DC, Borra V, Carlson JN, Cassan P, Chang WT, Charlton NP, Djärv T, Douma MJ, Epstein JL, Hood NA, Markenson DS, Meyran D, Orkin AM, Sakamoto T, Swain JM, Woodin JA. 2020 International Consensus on First Aid Science With Treatment Recommendations. Circulation 2020; 142:S284-S334. [PMID: 33084394 DOI: 10.1161/cir.0000000000000897] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This is the summary publication of the International Liaison Committee on Resuscitation's 2020 International Consensus on First Aid Science With Treatment Recommendations. It addresses the most recent published evidence reviewed by the First Aid Task Force science experts. This summary addresses the topics of first aid methods of glucose administration for hypoglycemia; techniques for cooling of exertional hyperthermia and heatstroke; recognition of acute stroke; the use of supplementary oxygen in acute stroke; early or first aid use of aspirin for chest pain; control of life-threatening bleeding through the use of tourniquets, hemostatic dressings, direct pressure, or pressure devices; the use of a compression wrap for closed extremity joint injuries; and temporary storage of an avulsed tooth. Additional summaries of scoping reviews are presented for the use of a recovery position, recognition of a concussion, and 6 other first aid topics. The First Aid Task Force has assessed, discussed, and debated the certainty of evidence on the basis of Grading of Recommendations, Assessment, Development, and Evaluation criteria and present their consensus treatment recommendations with evidence-to-decision highlights and identified priority knowledge gaps for future research.
Collapse
|