Tourniquet Use for Major Hemorrhage in Prehospital and Hospital Settings: A Systematic Review of the Literature

Abstract

Introduction: Major hemorrhage remains a leading cause of preventable death in both civilian and military trauma settings. Tourniquets have emerged as a critical intervention for hemorrhage control; however, their optimal application across various clinical environments requires systematic evaluation. Objective: To systematically review the effectiveness, safety, and clinical outcomes of tourniquet use for major extremity hemorrhage in prehospital and hospital settings. Materials and Methods: We conducted a comprehensive systematic search of PubMed, Scopus, Web of Science, and the Cochrane Library databases for studies published between 2000 and 2024. The inclusion criteria covered randomized controlled trials, cohort studies, and observational studies that assessed the use of tourniquets for major limb hemorrhage. Primary outcomes included survival rates, effectiveness of hemorrhage control, and complication rates. Secondary outcomes included time to hemorrhage control and functional results. Data extraction focused on clinical indications, patient demographics, tourniquet specifications, application timing, and adverse events. Results: Thirty-two studies met the inclusion criteria. Tourniquet use in the prehospital setting was consistently associated with improved survival in patients with severe extremity bleeding, particularly when applied early. Hospital-based tourniquet use has proven effective in surgical or resuscitative contexts but requires careful monitoring to avoid ischemic complications. When used correctly and for limited periods, complication rates remain low. Conclusions: The current evidence strongly supports the use of tourniquets as an effective and safe intervention for major extremity hemorrhage in both prehospital and hospital settings. The early application improves survival outcomes and helps reduce complications. Implementing standardized protocols, comprehensive training programs, and quality improvement initiatives is crucial to maximizing clinical benefits and ensuring patient safety.

Keywords

• tourniquet
• hemorrhage control
• trauma
• prehospital care
• systematic review