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Precise Limb Tourniquet Arterial Occlusion Pressure Determination using Real-Time Ultrasonography and a Capacitive-Based Force Sensor

Published online by Cambridge University Press:  18 October 2022

Jeffrey N. Wood ,
Benjamin S. Krippendorf ,
Craig A. Blakeney ,
Tobias Kummer ,
Alexander W. Hooke ,
Aidan F. Mullan  and
Matthew D. Sztajnkrycer Open the ORCID record for Matthew D. Sztajnkrycer [Opens in a new window]
Jeffrey N. Wood
Affiliation:
Division of Prehospital Care, Mayo Clinic, Rochester, Minnesota, USA Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
Benjamin S. Krippendorf
Affiliation:
Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
Craig A. Blakeney
Affiliation:
Division of Prehospital Care, Mayo Clinic, Rochester, Minnesota, USA Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
Tobias Kummer
Affiliation:
Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
Alexander W. Hooke
Affiliation:
Biomechanics Research Laboratory, Mayo Clinic, Rochester, Minnesota, USA
Aidan F. Mullan
Affiliation:
Department of Health Science Research, Mayo Clinic, Rochester, Minnesota, USA
Matthew D. Sztajnkrycer*
Affiliation:
Division of Prehospital Care, Mayo Clinic, Rochester, Minnesota, USA Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
*
Correspondence: Matthew D. Sztajnkrycer, MD, PhD Mayo Clinic Department of Emergency Medicine 200 First St SW Rochester, Minnesota 55905 USA E-mail: Sztajnkrycer.matthew@mayo.edu
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Abstract

Background:

Hemorrhage control prior to shock onset is increasingly recognized as a time-critical intervention. Although tourniquets (TQs) have been demonstrated to save lives, less is known about the physiologic parameters underlying successful TQ application beyond palpation of distal pulses. The current study directly visualized distal arterial occlusion via ultrasonography and measured associated pressure and contact force.

Methods:

Fifteen tactical officers participated as live models for the study. Arterial occlusion was performed using a standard adult blood pressure (BP) cuff and a Combat Application Tourniquet Generation 7 (CAT7) TQ, applied sequentially to the left mid-bicep. Arterial flow cessation was determined by radial artery palpation and brachial artery pulsed wave doppler ultrasound (US) evaluation. Steady state maximal generated force was measured using a thin-film force sensor.

Results:

The mean (95% CI) systolic blood pressure (SBP) required to occlude palpable distal pulse was 112.9mmHg (109-117); contact force was 23.8N [Newton] (22.0-25.6). Arterial flow was visible via US in 100% of subjects despite lack of palpable pulse. The mean (95% CI) SBP and contact force to eliminate US flow were 132mmHg (127-137) and 27.7N (25.1-30.3). The mean (95% CI) number of windlass turns to eliminate a palpable pulse was 1.3 (1.0-1.6) while 1.6 (1.2-1.9) turns were required to eliminate US flow.

Conclusions:

Loss of distal radial pulse does not indicate lack of arterial flow distal to upper extremity TQ. On average, an additional one-quarter windlass turn was required to eliminate distal flow. Blood pressure and force measurements derived in this study may provide data to guide future TQ designs and inexpensive, physiologically accurate TQ training models.

Keywords

forcehemorrhagepressuretourniquetwindlass
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 37 , Issue 6 , December 2022 , pp. 772 - 777
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Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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