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Emergencias. 2019 Ene;31(1):47-54.

Tourniquet use in out-of-hospital emergency care: a systematic review.

[Article in English, Spanish; Abstract available in Spanish from the publisher]

Author information

Unidad Quirúrgica y de Consultas Externas, Hospital Universitario Miguel Servet, Zaragoza, España.
Servicio de Urgencias, Hospital Comarcal de Vinaròs, Castellón, España.
Unidad de Cardiología, Hospital Universitario de Burgos, Burgos, España
Departamento de Obstetricia y Ginecología, Hospital Universitario de la Ribera, Alzira, Valencia, España
Departamento de Enfermería, Universidad Católica de Valencia San Vicente Mártir, Valencia, España.


in English, Spanish


Uncontrolled bleeding from serious injuries continues to be one of the main causes of preventable deaths outside hospitals. Tourniquets could be useful for quickly stemming blood flow and prevent exsanguination, although evidence supporting their use and effectiveness in civilian accidents is limited. To analyze the effectiveness of tourniquets for stopping bleeding in out-of-hospital emergencies and to explore factors associated with effectiveness.


We undertook a systematic review of the literature in Spanish and English. Search protocols to identify studies that evaluated the use of various devices and their effectiveness in stemming arterial blood flow. We included studies published between 2011 and 2016 in which tourniquets were used to prevent massive blood loss.


We included 17 articles. Tourniquets were effective in stopping massive bleeding in all studies. Pain, the most frequently described adverse effect, was observed in 420 patients (35.7%). Delayed application of a tourniquet was associated with more negative outcomes.


Tourniquets are effective for stopping massive blood loss. There are few complications, most of which are attributable to the critical state of patients rather than to application of the tourniquet. A tourniquet should be applied in major trauma cases in civilian settings if massive, life-threatening bleeding cannot be stopped with direct pressure.


Emergency medical services; Exanguinación; Exsanguination; Hemorragia; Hemorrhage; Servicios médicos de emergencia; Torniquetes; Tourniquets

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