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Precise Limb Tourniquet Arterial Occlusion Pressure Determination using Real-Time Ultrasonography and a Capacitive-Based Force Sensor

Published online by Cambridge University Press:  18 October 2022

Jeffrey N. Wood ,
Benjamin S. Krippendorf ,
Craig A. Blakeney ,
Tobias Kummer ,
Alexander W. Hooke ,
Aidan F. Mullan  and
Matthew D. Sztajnkrycer Open the ORCID record for Matthew D. Sztajnkrycer [Opens in a new window]
Jeffrey N. Wood
Affiliation:
Division of Prehospital Care, Mayo Clinic, Rochester, Minnesota, USA Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
Benjamin S. Krippendorf
Affiliation:
Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
Craig A. Blakeney
Affiliation:
Division of Prehospital Care, Mayo Clinic, Rochester, Minnesota, USA Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
Tobias Kummer
Affiliation:
Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
Alexander W. Hooke
Affiliation:
Biomechanics Research Laboratory, Mayo Clinic, Rochester, Minnesota, USA
Aidan F. Mullan
Affiliation:
Department of Health Science Research, Mayo Clinic, Rochester, Minnesota, USA
Matthew D. Sztajnkrycer*
Affiliation:
Division of Prehospital Care, Mayo Clinic, Rochester, Minnesota, USA Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
*
Correspondence: Matthew D. Sztajnkrycer, MD, PhD Mayo Clinic Department of Emergency Medicine 200 First St SW Rochester, Minnesota 55905 USA E-mail: [email protected]
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Abstract

Background:

Hemorrhage control prior to shock onset is increasingly recognized as a time-critical intervention. Although tourniquets (TQs) have been demonstrated to save lives, less is known about the physiologic parameters underlying successful TQ application beyond palpation of distal pulses. The current study directly visualized distal arterial occlusion via ultrasonography and measured associated pressure and contact force.

Methods:

Fifteen tactical officers participated as live models for the study. Arterial occlusion was performed using a standard adult blood pressure (BP) cuff and a Combat Application Tourniquet Generation 7 (CAT7) TQ, applied sequentially to the left mid-bicep. Arterial flow cessation was determined by radial artery palpation and brachial artery pulsed wave doppler ultrasound (US) evaluation. Steady state maximal generated force was measured using a thin-film force sensor.

Results:

The mean (95% CI) systolic blood pressure (SBP) required to occlude palpable distal pulse was 112.9mmHg (109-117); contact force was 23.8N [Newton] (22.0-25.6). Arterial flow was visible via US in 100% of subjects despite lack of palpable pulse. The mean (95% CI) SBP and contact force to eliminate US flow were 132mmHg (127-137) and 27.7N (25.1-30.3). The mean (95% CI) number of windlass turns to eliminate a palpable pulse was 1.3 (1.0-1.6) while 1.6 (1.2-1.9) turns were required to eliminate US flow.

Conclusions:

Loss of distal radial pulse does not indicate lack of arterial flow distal to upper extremity TQ. On average, an additional one-quarter windlass turn was required to eliminate distal flow. Blood pressure and force measurements derived in this study may provide data to guide future TQ designs and inexpensive, physiologically accurate TQ training models.

Keywords

forcehemorrhagepressuretourniquetwindlass
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 37 , Issue 6 , December 2022 , pp. 772 - 777
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Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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References

Kauvar, DS, Leferin, R, Wade, CE. Impact of hemorrhage on trauma outcome: an overview of epidemiology, clinical presentations, and therapeutic considerations. J Trauma. 2006;60(6 suppl):s3–s11.Google ScholarPubMed
Eastridge, BJ, Mabry, RL, Seguin, P, et al. Death on the battlefield (2001–2011): implications for the future of combat casualty care. J Trauma Acute Care Surg. 2012;73(6 suppl 5):s431–s437.CrossRefGoogle ScholarPubMed
Beekley, AC, Sebesta, JA, Blackbourne, LH, et al. Prehospital tourniquet use in Operation Iraqi Freedom: effect on hemorrhage control and outcomes. J Trauma. 2008;64(2 suppl):s28–s37.Google ScholarPubMed
Kragh, JF Jr, Littrel, ML, Jones, JA, et al. Battle casualty survival with emergency tourniquet use to stop limb bleeding. J Emerg Med. 2011;41(6):590–597.Google ScholarPubMed
Kragh, JF Jr, Walters, TJ, Baer, DG, et al. Practical use of emergency tourniquets to stop bleeding in major limb trauma. J Trauma. 2008;64(2 suppl):s38–s49.Google ScholarPubMed
Passos, E, Dingley, B, Smith, A, et al. Canadian Trauma Trials Collaborative. Tourniquet use for peripheral vascular injuries in the civilian setting. Injury. 2014;45(3):573–577.CrossRefGoogle ScholarPubMed
Callaway, DW, Robertson, J, Sztajnkrycer, MD. Law enforcement-applied tourniquets: a case series of life-saving interventions. Prehosp Emerg Care. 2015;19(2):320–327.CrossRefGoogle ScholarPubMed
Henry, R, Matsushima, K, Ghafil, C, et al. Increased use of prehospital tourniquet and patient survival: Los Angeles countywide study. J Am Coll Surg. 2021;233(2):233–239.Google ScholarPubMed
Scerbo, MH, Holcomb, JB, Taub, E, et al. The trauma center is too late: major limb trauma without a pre-hospital tourniquet has increased death from hemorrhagic shock. J Trauma Acute Care Surg. 2017;83(6):1165–1172.CrossRefGoogle ScholarPubMed
Mikdad, S, Mokhtari, AK, Luckhusrt, CM, et al. Implications of the Stop the Bleed Campaign: the swinging pendulum of prehospital tourniquet application in civilian limb trauma. J Trauma Acute Care Surg. 2021;91(2):352–360.CrossRefGoogle ScholarPubMed
Ross, EM, Mapp, JG, Redman, TT, Borown, DJ, Kharod, CU, Wampler, DA. The tourniquet gap: a pilot study of the intuitive placement of three tourniquet types by laypersons. J Emerg Med. 2018;54(3):307–314.CrossRefGoogle Scholar
Goralnick, E, Chaudhary, MA, McCart, JC, et al. Effectiveness of instructional interventions for hemorrhage control readiness of laypersons in the Public Access and Tourniquet Training Study (PATTS). A randomized clinical trial. JAMA Surg. 2018;153(9):791–799.CrossRefGoogle ScholarPubMed
Baruch, EN, Benov, A, Shina, A, et al. Does practice make perfect? Prospectively comparing effects of 2 amounts of practice on tourniquet use and performance. Am J Emerg Med. 2016;34(12):2356–2361.CrossRefGoogle Scholar
Tsur, AM, Binyamin, Y, Koren, L, Ohayon, S, Thompson, P, Glassberg, E. High tourniquet failure rates among non-medical personnel do not improve with tourniquet training, including combat stress inoculation: a randomized controlled trial. Prehosp Disaster Med. 2019;34(3):282–287.CrossRefGoogle Scholar
King, DR, Larentzakis, A, Ramly, EP; Trauma Collaborative, Boston. Tourniquet use at the Boston Marathon bombing: lost in translation. J Trauma Acute Care Surg. 2015;78(3):594–599 CrossRefGoogle ScholarPubMed
Stewart, SK, Duchesne, JC, Khan, MA. Improvised tourniquets: obsolete or obligatory. J Trauma Acute Care Surg. 2015;78(1):178–183.CrossRefGoogle ScholarPubMed
Walters, TJ, Wenke, JC, Greydanus, DJ, Kauvar, DS, Baer, DG. Laboratory Evaluation of Battlefield Tourniquets in Human Volunteers. USAISR Technical Report 2005-05. Fort Sam Houston, Texas USA: US Army Institute for Surgical Research; 2005.CrossRefGoogle Scholar
Hingtgen, E, Wall, P, Bruising, C. Characterizing a system for measuring limb tourniquet pressures. J Spec Oper Med. 2020;20(1):47–54.CrossRefGoogle ScholarPubMed
Wall, P, Buising, C, Sahr, S. Getting tourniquets right = getting tourniquets tight. J Spec Oper Med. 2019;19(3):52–63.CrossRefGoogle ScholarPubMed
Gibson, R, Aden, JK 3rd, Dubick, MA, Kragh, JF Jr. Preliminary comparison of pneumatic models of tourniquets for prehospital control of limb bleeding in a manikin model. J Spec Oper Med. 2016;16(2):21–27.Google Scholar
Lyles, WE III, Kragh, JF Jr, Aden, JK 3rd, Dubick, MA. Testing tourniquet use in a manikin model. Two improvised techniques. J Spec Oper Med. 2015;15(4):21–26.Google Scholar
Tuncali, B, Karci, A, Tuncali, BE, et al. A new method for estimating arterial occlusion pressure in optimizing pneumatic tourniquet inflation pressure. Anesth Analg. 2006;102(6):1752–1757.CrossRefGoogle ScholarPubMed
Griffin, LV, Kragh, JF Jr, Dubick, MA. Laboratory model of a collapsible tube to develop bleeding control interventions. Effects of compression on flow. J Spec Oper Med. 2018;18(1):47–52.CrossRefGoogle Scholar