Tourniquets (TQ) have been increasingly adopted in pre-hospital settings recently. This study examined the effectiveness and safety of applying TQ in the pre-hospital settings for civilian patients with traumatic vascular injuries to the extremities. We systematically searched the Ovid Embase, PubMed, and Cochrane Central Register of Controlled Trials databases from their inception to June 2023. We compared pre-hospital TQ (PH-TQ) use to no PH-TQ, defined as a TQ applied after hospital arrival or no TQ use at all, for civilian vascular extremity trauma patients. The primary outcome was overall mortality rate, and the secondary outcomes were blood product use and hospital stay. We analyzed TQ-related complications as safety outcomes. We tried to include randomized controlled trials (RCTs) and non-randomized studies (including non-RCTs, interrupted time series, controlled before-and-after studies, cohort studies, and case-control studies), if available. Pooled odds ratios (ORs) were calculated and the certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Seven studies involving 4,095 patients were included. In the primary outcome, pre-hospital TQ (PH-TQ) use significantly decrease mortality rate in patients with extremity trauma (odds ratio [OR], 0.48, 95% confidence interval [CI] 0.27–0.86, I2 = 47%). Moreover, the use of PH-TQ showed the decreasing trend of utilization of blood products, such as packed red blood cells (mean difference [MD]: -2.1 [unit], 95% CI: -5.0 to 0.8, I2 = 99%) or fresh frozen plasma (MD: -1.0 [unit], 95% CI: -4.0 to 2.0, I2 = 98%); however, both are not statistically significant. No significant differences were observed in the lengths of hospital and intensive care unit stays. For the safety outcomes, PH-TQ use did not significantly increase risk of amputation (OR: 0.85, 95% CI: 0.43 to 1.68, I2 = 60%) or compartment syndrome (OR: 0.94, 95% CI: 0.37 to 2.35, I2 = 0%). The certainty of the evidence was very low across all outcomes. The current data suggest that, in the pre-hospital settings, PH-TQ use for civilian patients with vascular traumatic injury of the extremities decreased mortality and tended to decrease blood transfusions. This did not increase the risk of amputation or compartment syndrome significantly.

中文翻译：

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院前使用止血带治疗民用血管肢体创伤的有效性和安全性：系统评价和荟萃分析


最近，止血带 (TQ) 在院前环境中越来越多地采用。本研究检验了在院前对四肢血管外伤的平民患者应用 TQ 的有效性和安全性。我们系统地检索了 Ovid Embase、PubMed 和 Cochrane 对照试验中央注册数据库，从其建立到 2023 年 6 月。我们将院前 TQ (PH-TQ) 的使用与不使用 PH-TQ（定义为入院后应用的 TQ）进行了比较对于民用血管肢体创伤患者，或者根本不使用 TQ。主要结局是总体死亡率，次要结局是血液制品的使用和住院时间。我们分析了 TQ 相关并发症作为安全结果。如果有的话，我们尝试纳入随机对照试验 (RCT) 和非随机研究（包括非 RCT、中断时间序列、前后对照研究、队列研究和病例对照研究）。计算汇总比值比 (OR)，并使用建议评估、制定和评估分级 (GRADE) 方法评估证据的确定性。纳入了 7 项研究，涉及 4,095 名患者。在主要结局中，院前 TQ (PH-TQ) 的使用显着降低了四肢创伤患者的死亡率（优势比 [OR]，0.48，95% 置信区间 [CI] 0.27–0.86，I2 = 47%）。此外，PH-TQ的使用显示血液制品（例如浓缩红细胞）的利用率呈下降趋势（平均差[MD]：-2.1[单位]，95％CI：-5.0至0.8，I2 = 99％ ）或新鲜冰冻血浆（MD：-1.0 [单位]，95% CI：-4.0 至 2.0，I2 = 98%）；然而，两者都不具有统计显着性。 住院和重症监护病房的住院时间没有观察到显着差异。对于安全性结果，使用 PH-TQ 并未显着增加截肢风险（OR：0.85，95% CI：0.43 至 1.68，I2 = 60%）或筋膜室综合征（OR：0.94，95% CI：0.37 至 2.35， I2 = 0%）。所有结果的证据质量都非常低。目前的数据表明，在院前环境中，对四肢血管创伤性损伤的平民患者使用 PH-TQ 可降低死亡率，并倾向于减少输血。这并没有显着增加截肢或骨筋膜室综合征的风险。