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The Certification Matters: A Comparative Performance Analysis of Combat Application Tourniquets versus Non-Certified CAT Look-Alike Tourniquets

Published online by Cambridge University Press:  22 August 2023

Emanuele Lagazzi Open the ORCID record for Emanuele Lagazzi [Opens in a new window] ,
Giulia Ballardini ,
Alberto Drogo ,
Ludovica Viola ,
Eva Marrone ,
Valerio Valente ,
Michele Bonetti ,
Jarone Lee ,
David R. King  and
Serena Ricci
Emanuele Lagazzi*
Affiliation:
Department of Surgery, Humanitas Research Hospital, Rozzano, Lombardia, Italy Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts USA Italian Trauma League ODV, Genova, Italy
Giulia Ballardini
Affiliation:
Department of Informatics, Bioengineering, Robotics, and Systems Engineering, University of Genova, Genova, Italy Max Planck Institute for Intelligent Systems, Stuttgart, Germany
Alberto Drogo
Affiliation:
Italian Trauma League ODV, Genova, Italy School of Medical and Pharmaceutical Sciences, University of Genova, Genova, Italy
Ludovica Viola
Affiliation:
Department of Informatics, Bioengineering, Robotics, and Systems Engineering, University of Genova, Genova, Italy
Eva Marrone
Affiliation:
Italian Trauma League ODV, Genova, Italy School of Medical and Pharmaceutical Sciences, University of Genova, Genova, Italy
Valerio Valente
Affiliation:
Italian Trauma League ODV, Genova, Italy Department of Anesthesia and Intensive Care Unit, University of Modena and Reggio Emilia, Modena, Emilia-Romagna, Italy
Michele Bonetti
Affiliation:
Italian Trauma League ODV, Genova, Italy Schwarzwald-Baar Klinikum, University Hospital of the University of Freiburg - Division of Anesthesia and Intensive - Emergency and Pain Medicine Villingen-Schwenningen, Freiburg, Baden-Württemberg, Germany
Jarone Lee
Affiliation:
Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts USA
David R. King
Affiliation:
Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts USA
Serena Ricci
Affiliation:
Department of Informatics, Bioengineering, Robotics, and Systems Engineering, University of Genova, Genova, Italy Simulation and Advanced Education Center, University of Genova, Genova, Liguria, Italy
*
Correspondence: Emanuele Lagazzi, MD Division of Trauma, Emergency Surgery, and Surgical Critical Care Massachusetts General Hospital 165 Cambridge St, Suite 810 Boston, Massachusetts 02114 USA E-mail: elagazzi@mgh.harvard.edu
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Abstract

Introduction:

The Stop the Bleed campaign provided civilians with tourniquet application training and increased the demand for tourniquets among the general population, which led to the development of new commercially available devices. However, most widely available tourniquets have not undergone testing by regulatory bodies and their efficacy remains unknown.

Study Objective:

This study aimed to compare the efficacy and performance of Combat Application Tourniquets (CAT) versus uncertified tourniquets.

Methods:

This study compared 25 CAT with 50 commercially available “look-alike” tourniquets (LA-TQ) resembling the CAT. The CAT and the LA-TQ were compared for cost, size, and tested during one-hour and six-hour applications on a manikin’s leg. The outcomes were force applied, force variation during the application, and tourniquet rupture rate.

Results:

The LA-TQ were cheaper (US$6.07 versus US$27.19), shorter, and had higher inter-device variability than the CAT (90.1 [SE = 0.5] cm versus 94.5 [SE = 0.1] cm; P <.001). The CAT applied a significantly greater force during the initial application when compared to the LA-TQ (65 [SE = 3] N versus 14 [SE = 1] N; P <.001). While the initial application force was maintained for up to six hours in both groups, the CAT group applied an increased force during one-hour applications (group effect: F [1,73] = 105.65; P <.001) and during six-hour applications (group effect: F [1,12] = 9.79; P = .009). The rupture rate differed between the CAT and the LA-TQ (0% versus 4%).

Conclusion:

The LA-TQ applied a significantly lower force and had a higher rupture rate compared to the CAT, potentially affecting tourniquet performance in the context of public bleeding control. These findings warrant increased layperson education within the framework of the Stop the Bleed campaign and further investigations on the effectiveness of uncertified devices in real-world applications.

Keywords

bleedinghemorrhageprehospitalStop the Bleedtourniquet
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 38 , Issue 4 , August 2023 , pp. 450 - 455
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Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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Footnotes

Note: Drs. E. Lagazzi and G. Ballardini contributed equally to this manuscript.

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