A Multi-Institutional Study of Hemostatic Gauze and Tourniquets in Rural Civilian Trauma.

Background: Life threatening hemorrhage is a leading cause of preventable mortality in trauma patients. Since publication of the Hartford Consensus statement there has been intense interest in civilian use of commercial hemostatic gauze and tourniquets. Although the military has studied their use on soldiers with wartime injuries, there is limited data on patient outcomes following civilian pre-hospital use and no data on the use in rural trauma. Methods: We performed a multi-institutional retrospective analysis of clinical outcomes following prehospital use of QuikClot Combat Gauze (QC) and Combat Application Tourniquets (CAT) from 2009-2014. The primary outcome measured was effectiveness. Secondary outcomes included morbidity, mortality, patient demographics, injury characteristics, and hospital outcomes. Results: Between 2009 and 2014, 95 patients were managed by prehospital personnel with QC and/or CAT. Forty received QC, 61 CAT, and 6 with both products. The median age was 40 years (6-91), 29% were female, and the median ISS was 7 (1-25). QC was 89% effective. Minimal morbidity was associated with QC use. CAT was 98% effective. Median tourniquet time was 21 minutes (6-142), the median ISS was 9 (1-50), and mortality was 9.8%. Morbidities observed with tourniquet use included amputation, fasciotomy, rhabdomyolysis and acute kidney injury. Risk of amputation was associated with higher injury severity (p = 0.04) but not with elderly age, obesity, or the presence of medical comorbidities. No amputations resulted solely from the use of tourniquets. Conclusions: QC and CAT are safe and effective adjuncts for hemorrhage control in the rural civilian trauma across a wide range of injury patterns. In a rural civilian population including women, children and elderly patients with medical comorbidities, these devices are associated with minimal morbidity beyond that of the original injury. Level of Evidence: Epidemiologic/prognostic study, level III (C) 2016 Lippincott Williams & Wilkins, Inc.

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