LA County study finds tourniquets improve survival, don’t increase amputation risk

By Laura French

LOS ANGELES COUNTY, Calif. — A study conducted in Los Angeles County, Calif. found that increased tourniquet use over the last few years has improved outcomes for trauma patients without increasing amputation risks.

Researchers from the University of Southern California examined data from EMS provider and trauma registries at the Los Angeles County Department of Health Services EMS Agency collected between October 2015 and July 2019, according to the American College of Surgeons. The study, published in the Journal of the American College of Surgeons, compared the data for trauma center patients with extremity vascular injuries who had a prehospital tourniquet placed versus those who did not have a prehospital tourniquet placed, and measured factors including in-hospital mortality rate, length of hospital stay, delayed amputation rates and blood transfusions needed.

The researchers found that those who had a prehospital tourniquet placed had about a 1% mortality rate compared with 8.9% for patients who did not have a tourniquet placed. The study also found that patients without tourniquets received an average of about 1 liter of blood after four hours and 2.5 liters of blood after 24 hours, compared with half a liter and 1 liter, respectively, for patients with a tourniquet.

The study authors noted that the average length of hospital stay, length of ICU stay and delayed amputation rates were about the same for both groups. The rate of tourniquet use on patients with extremity vascular injury increased from 8.5% in 2017 to 18.1% in 2019.

Photo/American College of Surgeons

“A higher number of tourniquets placed was associated with improved mortality and decreased requirements for transfusions and no difference in the rate of amputations,” said lead study author Reynold Henry, MD, MPH, in a statement.

Henry, who is a general surgery chief resident at the LAC+USC Medical Center, said the STOP THE BLEED public awareness campaign was a factor in increasing the rate of prehospital tourniquet use in Los Angeles County.

“On a local, state, and federal level, policy needs to reflect that getting tourniquets into public spaces and mandatory STOP THE BLEED training for certain types of jobs can go a long way. That is something that we, as surgeons, should be advocating for,” Henry stated.