Appropriate Tourniquet Types in the Pediatric Population: A Systematic Review.
bleeding
first-aid
hemorrhage
pediatric
tourniquet
Journal
Cureus
ISSN: 2168-8184
Titre abrégé: Cureus
Pays: United States
ID NLM: 101596737
Informations de publication
Date de publication:
13 Apr 2021
13 Apr 2021
Historique:
entrez:
17
5
2021
pubmed:
18
5
2021
medline:
18
5
2021
Statut:
epublish
Résumé
Trauma is the leading cause of mortality in those aged 1-19, with hemorrhage accounting for up to 40% of all trauma deaths. Manufactured tourniquets are recommended for the control of life-threatening extremity hemorrhage in adults but their use in the pediatric population requires further investigation. We performed a systematic review to evaluate the most appropriate tourniquet design for use in the pediatric population. A literature search of Embase and the Cochran databases of trials and systematic reviews on October 1, 2020 identified 454 unique references, of which 15 were included for full-text screening. Two single-arm observational studies with a high risk of bias evaluated the use of windlass tourniquets in the pediatric population (73 patients, age 2-16 years). The certainty of the evidence was very low. In both studies, conducted on uninjured extremities, the use of a manufactured windlass tourniquet, specifically the Combat Application Tourniquet (C-A-T®) Generation 7, led to the cessation of Doppler detected pulses in 71/71 (100%) of upper extremities and 69/73 (94.5%) of lower extremities. Of the four failures, one participant withdrew due to pain and three tourniquet applications failed to occlude pulses after three turns of the windlass. No controls were used for comparison. In conclusion, two observational studies demonstrated that windlass tourniquets were able to abolish distal pulses in children as young as two years of age and with a minimum limb circumference of 13 cm. These preliminary findings may be helpful for organizations in the creation of guidelines for the management of life-threatening extremity bleeding in children.
Identifiants
pubmed: 33996333
doi: 10.7759/cureus.14474
pmc: PMC8118807
doi:
Types de publication
Journal Article
Review
Langues
eng
Pagination
e14474Informations de copyright
Copyright © 2021, Charlton et al.
Déclaration de conflit d'intérêts
Disclaimer for Dr Craig Goolsby: This article is the opinion of the authors and does not reflect the official policy or position of the Uniformed Services University, Defense Department, or US Government.
Références
J Trauma. 1995 Feb;38(2):185-93
pubmed: 7869433
J Trauma. 2006 Jun;60(6 Suppl):S3-11
pubmed: 16763478
J Trauma Acute Care Surg. 2020 May;88(5):644-647
pubmed: 31977996
J Spec Oper Med. 2019 Summer;19(2):41-47
pubmed: 31201750
J Trauma Acute Care Surg. 2015 Dec;79(6):983-9; discussion 989-90
pubmed: 26680137
Pediatrics. 2019 Jun;143(6):
pubmed: 31064797
Circulation. 2020 Oct 20;142(16_suppl_1):S284-S334
pubmed: 33084394
Mil Med. 2019 Mar 1;184(Suppl 1):361-366
pubmed: 30901457
Circulation. 2020 Oct 27;142(17):e287-e303
pubmed: 33084370
J Trauma Acute Care Surg. 2018 Oct;85(4):665-667
pubmed: 29462083
Prehosp Emerg Care. 2017 Oct 5;:1-50
pubmed: 28980864
Acad Pediatr. 2021 Mar;21(2):321-328
pubmed: 32473216
Pediatrics. 2017 Sep;140(3):
pubmed: 28827377
Prehosp Emerg Care. 2021 Mar-Apr;25(2):235-267
pubmed: 32208060
Pediatr Emerg Care. 2012 Dec;28(12):1361-5
pubmed: 23187998
J Trauma Acute Care Surg. 2020 Oct;89(4):716-722
pubmed: 32590562
Prehosp Emerg Care. 2017 Jan-Feb;21(1):39-45
pubmed: 27494564
Am J Lifestyle Med. 2017;13(1):7-21
pubmed: 28845146
J Spec Oper Med. 2013 Winter;13(4):94-107
pubmed: 24227567