Tourniquets and occlusion: the pressure of design

Nerve injuries result from tourniquet pressure. The objective was to determine arterial occlusion and completion pressures with the 3.8-cm-wide windlass Combat Application Tourniquet (CAT) and the 10.4-cm-wide Stretch, Wrap, and Tuck Tourniquet (SWAT-T). Sixteen volunteers self-applied and had tourn...

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Bibliographic Details
Published in:Military medicine 2013-05, Vol.178 (5), p.578-587
Main Authors: Wall, Piper L, Duevel, David C, Hassan, Mohamed B, Welander, John D, Sahr, Sheryl M, Buising, Charisse M
Format: Article
Language:English
Subjects:
Adult
Bladder
Blood pressure
Design
Emergency Medical Services - methods
Equipment Design
Female
Follow-Up Studies
Hemorrhage - physiopathology
Hemorrhage - therapy
Humans
Male
Middle Aged
Peripheral Nerve Injuries - prevention & control
Pressure
Pressure distribution
Prospective Studies
Sensors
Software
Time Factors
Tourniquets
Young Adult
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Summary:Nerve injuries result from tourniquet pressure. The objective was to determine arterial occlusion and completion pressures with the 3.8-cm-wide windlass Combat Application Tourniquet (CAT) and the 10.4-cm-wide Stretch, Wrap, and Tuck Tourniquet (SWAT-T). Sixteen volunteers self-applied and had tourniquets applied to their thighs and arms (CAT and SWAT-T, random order, then blood pressure cuffs). Occlusion (Doppler signal elimination) pressures were higher than predicted (p < 0.0001), highest with the CAT (p < 0.0001), and often lower than completion pressures (completion median, range: CAT 360, 147-745 mm Hg; SWAT-T 290, 136-449 mm Hg; cuff 184, 108-281 mm Hg). Three CAT thigh and 9 CAT arm completion pressures were >500 mm Hg. Pressure decreases and occlusion losses occurred over 1 minute (pressure decrease: CAT 44 ± 33 mm Hg; SWAT-T 6 ± 8 mm Hg; cuff 14 ± 19 mm Hg; p < 0.0001; loss/initially occluded: CAT 17 of 61, SWAT-T 5 of 61, cuff 40 of 64, p < 0.01). CAT pressures before turn did not have a clear relationship with turns to occlusion. Limb circumference/tourniquet width occlusion pressure predictions are not good substitutes for measurements. The wider SWAT-T has lower occlusion and completion pressures than the CAT. Decreases in muscle tension lead to decreases in tourniquet pressure, especially with the nonelastic CAT, which can lead to occlusion loss.
ISSN:0026-4075
1930-613X
DOI:10.7205/MILMED-D-12-00490