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Systematic Review

Effectiveness of Pre-Hospital Tourniquet in Emergency Patients with Major Trauma and Uncontrolled Haemorrhage: A Systematic Review and Meta-Analysis

1
National Centre for Clinical Excellence Healthcare Quality and Safety, Istituto Superiore di Sanità, Via Giano della Bella 34, 00162 Rome, Italy
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Department of Health Promotion Science, Maternal and Infant Care, Internal Medicine and Medical Specialities, University of Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy
3
IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Roma, Italy
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Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milan, Italy
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Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy
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National Centre for Health Technology Assessment, Istituto Superiore di Sanità, Via Giano della Bella 34, 00162 Rome, Italy
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General Surgery and Trauma Team, ASST Grande Ospedale Metropolitano Niguarda, University of Milan, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
*
Author to whom correspondence should be addressed.
Co-first authors.
Current Address: Centro Nazionale per l’Eccellenza Clinica, Qualità e Sicurezza delle Cure (CNEC), Istituto Superiore di Sanità, Via Giano della Bella, 34, 00162 Rome, Italy.
§
Co-last authors.
Membership of the Italian National Institute of Health Guideline Working Group on Major Trauma is provided in the Acknowledgments.
Academic Editors: Emily Ying Yang Chan and Holly Ching Yu Lam
Int. J. Environ. Res. Public Health 2021, 18(23), 12861; https://doi.org/10.3390/ijerph182312861
Received: 15 October 2021 / Revised: 25 November 2021 / Accepted: 26 November 2021 / Published: 6 December 2021
Trauma is one of the leading causes of uncontrolled haemorrhage, death, and disability. Use of a tourniquet can be considered an optimal anti-haemorrhagic resource, in pre-hospital and emergency settings, and its lifesaving effect is clinically contradictory. This review aims to assess the clinical efficacy of the tourniquet in the emergency pre-hospital care setting for the management of haemorrhage. We conducted the systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, the PRISMA statement. We searched the following electronic databases: EMBASE, MEDLINE, and Cochrane-CENTRAL. All studies included were appraised for risk of bias. Prevalent primary outcomes were mortality and use of blood products. Secondary outcomes were related to adverse effects. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach (GRADE). Four studies were involved (1762 trauma patients). The adjusted odds ratio (aOR) of 0.47 (95% confidence Interval (CI) 0.19–1.16; three studies; 377 patients) for overall mortality estimates did not give a clear indication of the benefits of emergency pre-hospital tourniquets (PH-TQ) versus no pre-hospital tourniquet (NO PH-TQ) placement. The adjusted mean difference for blood product use was −3.28 (95% CI −11.22, 4.66) for packed red blood cells (pRBC) and −4.80 (95% CI −5.61, −3.99) for plasma, respectively. The certainty of evidence was downgraded to very low for all outcomes. Our results suggest an unclear effect of emergency pre-hospital tourniquet placement on overall mortality and blood product use. However, this systematic review highlights the availability of only observational studies and the absence of high quality RCTs assessing the efficacy of PH-TQs. Randomized controlled trials are needed. View Full-Text
Keywords: systematic review; tourniquet; haemorrhage; emergencies; meta-analysis systematic review; tourniquet; haemorrhage; emergencies; meta-analysis
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MDPI and ACS Style

Latina, R.; Iacorossi, L.; Fauci, A.J.; Biffi, A.; Castellini, G.; Coclite, D.; D’Angelo, D.; Gianola, S.; Mari, V.; Napoletano, A.; Porcu, G.; Ruggeri, M.; Iannone, P.; Chiara, O.; on behalf of INIH—Major Trauma. Effectiveness of Pre-Hospital Tourniquet in Emergency Patients with Major Trauma and Uncontrolled Haemorrhage: A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health 2021, 18, 12861. https://doi.org/10.3390/ijerph182312861

AMA Style

Latina R, Iacorossi L, Fauci AJ, Biffi A, Castellini G, Coclite D, D’Angelo D, Gianola S, Mari V, Napoletano A, Porcu G, Ruggeri M, Iannone P, Chiara O, on behalf of INIH—Major Trauma. Effectiveness of Pre-Hospital Tourniquet in Emergency Patients with Major Trauma and Uncontrolled Haemorrhage: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health. 2021; 18(23):12861. https://doi.org/10.3390/ijerph182312861

Chicago/Turabian Style

Latina, Roberto, Laura Iacorossi, Alice J. Fauci, Annalisa Biffi, Greta Castellini, Daniela Coclite, Daniela D’Angelo, Silvia Gianola, Veronica Mari, Antonello Napoletano, Gloria Porcu, Matteo Ruggeri, Primiano Iannone, Osvaldo Chiara, and on behalf of INIH—Major Trauma. 2021. "Effectiveness of Pre-Hospital Tourniquet in Emergency Patients with Major Trauma and Uncontrolled Haemorrhage: A Systematic Review and Meta-Analysis" International Journal of Environmental Research and Public Health 18, no. 23: 12861. https://doi.org/10.3390/ijerph182312861

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