Tourniquet Usage in Pre-Hospital Care and Resuscitation of Pediatric Trauma Patients – Pediatric Trauma Society Position Statement

AbstractBACKGROUNDRecent mass casualty events in the United States have highlighted the need for public preparedness to prevent death from uncontrolled hemorrhage. The Pediatric Trauma Society (PTS) reviewed the literature regarding pediatric tourniquet usage with the aim to provide recommendations about the utility of this adjunct for hemorrhage control in children.METHODSSearch terms “pediatric” and “tourniquet” were used to query the US National Library of Medicine National Institutes of Health for pertinent literature. Exclusion criteria include: not involving children, not involving the use of an extremity tourniquet, primary outcomes not related to hemorrhage control, tourniquet use to prevent snake envenomation, single case reports, and only foreign language formats available. Bibliographies of remaining studies reviewed to identify additional pertinent research. Four physician members of the Pediatric Trauma Society Guidelines Committee reviewed identified studies.RESULTSOne hundred and thirty four studies were identified. One hundred and twenty three studies were excluded. Seven additional studies were identified through bibliography review. Eighteen pertinent studies were reviewed. Seven articles evaluated physiologic response to tourniquet use in operating room settings. Six articles were generated from combat experience in conflicts in Afghanistan and Iraq. Four articles discussed technical details of tourniquet usage. One article evaluated the use of tourniquets during the Boston Marathon bombing in 2015.CONCLUSIONSDespite limited data of limited quality regarding their use, the PTS supports the usage of tourniquets in the pre-hospital setting and during the resuscitation of children suffering from exsanguinating hemorrhage from severe extremity trauma. Expedited, definitive care must be sought, and tourniquet pressure and time should be limited to the least amount possible. The Society supports the ACS ‘Stop the Bleed’ campaign and encourages further investigation of tourniquet use in children.LEVEL OF EVIDENCE:3aSTUDY TYPEGuidelines/Algorithm BACKGROUND Recent mass casualty events in the United States have highlighted the need for public preparedness to prevent death from uncontrolled hemorrhage. The Pediatric Trauma Society (PTS) reviewed the literature regarding pediatric tourniquet usage with the aim to provide recommendations about the utility of this adjunct for hemorrhage control in children. METHODS Search terms “pediatric” and “tourniquet” were used to query the US National Library of Medicine National Institutes of Health for pertinent literature. Exclusion criteria include: not involving children, not involving the use of an extremity tourniquet, primary outcomes not related to hemorrhage control, tourniquet use to prevent snake envenomation, single case reports, and only foreign language formats available. Bibliographies of remaining studies reviewed to identify additional pertinent research. Four physician members of the Pediatric Trauma Society Guidelines Committee reviewed identified studies. RESULTS One hundred and thirty four studies were identified. One hundred and twenty three studies were excluded. Seven additional studies were identified through bibliography review. Eighteen pertinent studies were reviewed. Seven articles evaluated physiologic response to tourniquet use in operating room settings. Six articles were generated from combat experience in conflicts in Afghanistan and Iraq. Four articles discussed technical details of tourniquet usage. One article evaluated the use of tourniquets during the Boston Marathon bombing in 2015. CONCLUSIONS Despite limited data of limited quality regarding their use, the PTS supports the usage of tourniquets in the pre-hospital setting and during the resuscitation of children suffering from exsanguinating hemorrhage from severe extremity trauma. Expedited, definitive care must be sought, and tourniquet pressure and time should be limited to the least amount possible. The Society supports the ACS ‘Stop the Bleed’ campaign and encourages further investigation of tourniquet use in children. LEVEL OF EVIDENCE: 3a STUDY TYPE Guidelines/Algorithm Presented at the 4th Annual Meeting of the Pediatric Trauma Society, November 4, 2017 in Charleston, SC. Conflicts of Interest: None Financial Disclosures: None © 2018 Lippincott Williams & Wilkins, Inc.

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