The effectiveness of junctional tourniquets: a systematic review and meta-analysis

Background Junctional tourniquets have been incorporated into tactical combat casualty care for junctional vascular trauma. They apply external compression to stop blood flow in the groin and axilla. Objectives The primary outcome was effectiveness in achieving arterial occlusion. Secondary outcomes included time to application and pain scores. Data sources Medline and EMBASE databases were searched. Study appraisal and synthesis methods A random effects meta-analysis was conducted to estimate the average effectiveness and time to effective application for each device. Results Eight studies reported the effectiveness of junctional tourniquets in healthy volunteers. The average effectiveness was 52% (95% CI: 15-87%) for the abdominal application of the Abdominal Aortic and Junctional Tourniquet (AAJT), 83% (95% CI: 73 to 89%, I2: 26%) for the Junctional Emergency Treatment Tool (JETT), 87% (95% CI: 79 to 92%, I2: 15%) for the SAM Junctional Tourniquet (SJT), and 95% (95% CI: 90-98%) for the Combat Ready Clamp (CRoC). The groin application of the AAJT was studied in two papers with 100% in both studies. The average time to application was 101 seconds for the SJT (95% CI: 50-152 seconds) and the CRoC (95% CI: 63-139 seconds), while it was 130 seconds (95% CI: 85 to 176 seconds) for the JETT. The abdominal application of AAJT had a time to application of 92 and 171 seconds in two studies. Limitations All studies were conducted in healthy volunteers. Conclusions and implications Junctional tourniquets may meet a medical need in combat, and in the civilian environment, to control hemorrhage from these difficult injuries. All four FDA-approved devices demonstrate the ability to achieve vascular occlusion in healthy volunteers; however, effectiveness in patient transport has not been evaluated, and outcomes of their use in the field needs to be captured and reported. Level of Evidence Systematic review, level III This paper has been submitted for consideration for presentation at the 32nd EAST Annual Scientific Assembly will be held January 15-19, 2019 in Austin Texas. Corresponding author: Shane Smith, MD MSc, University of Western Ontario, University Hospital, 339 Windermere Road room C8-144, London, Ontario Canada N6A 5A5. shane.smith@lhsc.on.ca Disclosure of funding: none to disclose. SS, JW, AB and RH are members of the Canadian Armed Forces. The views expressed in this paper are those of the authors and do not constitute the views or policies of the Canadian Armed Forces. © 2018 Lippincott Williams & Wilkins, Inc.

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