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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院前环境中使用止血带治疗平民血管肢体创伤的有效性和安全性：系统评价和荟萃分析


止血带 （TQ） 最近越来越多地用于院前环境。本研究检查了在院前环境中对四肢创伤性血管损伤的平民患者应用 TQ 的有效性和安全性。我们系统检索了从建库到2023年6月的Ovid Embase、PubMed和Cochrane对照试验中心注册库。我们将院前 TQ （PH-TQ） 使用与无 PH-TQ 进行了比较，PH-TQ 定义为在到达医院后应用 TQ 或根本不使用 TQ，用于平民血管肢体创伤患者。主要结局是总死亡率，次要结局是血液制品使用和住院时间。我们分析了 TQ 相关并发症作为安全性结局。我们尝试纳入随机对照试验（randomized controlled trials， RCTs）和非随机研究（包括非随机对照试验、中断时间序列、前后对照研究、队列研究和病例对照研究），如果有的话。计算合并比值比 （ORs），并使用建议分级评估、开发和评价 （GRADE） 方法评估证据质量。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） 的使用显著降低了肢体创伤患者的死亡率 （比值比 [OR]，0.48,95% 置信区间 [CI] 0.27-0.86，I2 = 47%）。此外，PH-TQ 的使用显示出血液制品利用的下降趋势，例如浓缩红细胞（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%）;但是，两者都没有统计学意义。 在住院时间和重症监护病房的住院时间方面未观察到显著差异。对于安全性结局，PH-TQ 的使用不会显著增加截肢 （OR： 0.85， 95% CI： 0.43 至 1.68， I2 = 60%） 或骨筋膜室综合征 （OR： 0.94， 95% CI： 0.37 至 2.35， I2 = 0%） 的风险。所有结局的证据质量都非常低。目前的数据表明，在院前环境中，对患有四肢血管外伤的平民患者使用 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筋膜室综合征的风险。