Use of tourniquets for hemorrhage control in civilian and military prehospital settings: metabolic, hemodynamic, and anatomical complications derived from exposure time

INTRODUCTION: Haemorrhage control is an essential component in the management of traumatized patients, given its significant global contribution of approximately 1.5 million annual deaths. Extremities, prone to bleeding, offer opportunities for early haemostatic intervention, recognizing tourniquets as critical lifesaving tools in severe limb injuries. Despite global acceptance in medical guidelines, concerns persist regarding ischaemic complications and limb loss associated with tourniquet application, especially in civilian settings. This scoping review aims to examine current literature on the use of tourniquets for haemorrhage control in both civilian and military settings. It seeks to assess metabolic, haemodynamic, and anatomical complications derived from tourniquet exposure duration. MATERIAL AND METHODS: A search strategy was conducted following JBI and PRISMA-ScR protocols in PubMed databases. Study characteristics, setting, tourniquet time, environment, and reported complications were extracted from eligible studies. RESULTS: The literature review identified 2094 studies, of which 9 met the inclusion criteria. These studies mainly originated from North America and Europe, with 8 being retrospective analyses. Characteristics of 2,136 participants who received tourniquet applications were evaluated, with 84.8% male representation. Complications were detailed in relation to exposure times, ranging from 22 to 268 minutes, revealing diverse outcomes, including temporary paraesthesia, acute kidney injury, nerve compression injuries, rhabdomyolysis, ischaemia/reperfusion injuries, and compartment syndrome. CONCLUSIONS: This scoping review highlights the scarcity of local data and the need for a comprehensive assessment of tourniquet use in different traumatic scenarios. Understanding the specific impact of prolonged tourniquet application on clinical outcomes and complication rates is crucial for formulating guidelines and effective interventions in prehospital care.