J Trauma Acute Care Surg. 2019 Mar;86(3):532-539

# The effectiveness of junctional tourniquets: A systematic review and meta-analysis.

Smith S, White J, Wanis K, Beckett A, McAlister V, Hilsden R.

BACKGROUND: Junctional tourniquets have been incorporated into tactical combat casualty care for junctional vascular trauma. They apply external compression to stop blood flow in the groin and axilla.

OBJECTIVES: The primary outcome was effectiveness in achieving arterial occlusion. Secondary outcomes included time to application and pain scores.

DATA SOURCES: Medline and EMBASE databases were searched.

STUDY APPRAISAL AND SYNTHESIS METHODS: A random-effects meta-analysis was conducted to estimate the average effectiveness and time to effective application for each device.

RESULTS: Eight studies reported the effectiveness of junctional tourniquets in healthy volunteers. The average effectiveness was 52% (95% confidence interval [CI], 15-87%) for the abdominal application of the abdominal aortic and junctional tourniquet (AAJT), 83% (95% CI, 73-89%; 26%) for the junctional Emergency Treatment Tool, 87% (95% CI, 79-92%; 15%) for the SAM junctional tourniquet (SJT), and 95% (95% CI, 90-98%) for the Combat Ready Clamp. The groin application of the AAJT was studied in two articles with 100% in both studies. The average time to application was 101 seconds for the SAM junctional tourniquet (95% CI, 50-152 seconds) and the Combat Ready Clamp (95% CI, 63-139 seconds), while it was 130 seconds (95% CI, 85-176 seconds) for the Junctional Emergency Treatment Tool. The abdominal application of AAJT had an average time to application of 92 and 171 seconds in two studies.

LIMITATIONS: All studies were conducted in healthy volunteers.

CONCLUSION AND IMPLICATIONS: Junctional tourniquets may meet a medical need in combat, and in the civilian environment, to control hemorrhage from these difficult injuries. All four Food and Drug Administration-approved devices demonstrate the ability to achieve vascular occlusion in healthy volunteers; however, effectiveness in patient transport has not been evaluated, and outcomes of their use in the field need to be captured and reported.

LEVEL OF EVIDENCE: Systematic review, level III.