Page 69 - JSOM Spring 2024

The Use of Tourniquets in the Russo-Ukrainian War

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Igor M. Samarskyi, MD, PhD ; Eduard M. Khoroshun, MD ;
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Yurii M. Vorokhta, MD, PhD *

ABSTRACT
Aim: The objective of the study was to evaluate the use of tourni- windlass rod tightening systems, such as the Combat Appli-
quets in the Russo-Ukrainian war. Methods: The type, number, cation Tourniquet (CAT), are likely to be used the most by
and duration of tourniquets per limb, the clinical course of limb NATO military personnel. Elastic Esmarch-type tourniquets
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injuries, and the functional status of the injured limbs during were widely used in the Soviet army and are still in use in a
the 24 hours post-injury were evaluated in military hospital fa- majority of post-Soviet states. The type and duration of tourni-
cilities for the period of 2014–2022. Statistical frequencies and quets used to manage casualties in the Russo-Ukrainian war is
variances were analyzed. Results: During active hostilities, the unknown. The purpose of the study was to evaluate tourniquet
medical units of the Southern Operational Command received use in the Russo-Ukrainian war.
2,496 patients with limb injuries that required the application
of tourniquets. Lower extremity injuries were predominantly Methods
observed (84.4%). A single tourniquet was used in 1,538 cases
(61.6%), whereas two tourniquets were used in 533 (21.4%), Data were collected for the years 2014–2022, which includes
and three tourniquets in 425 cases (17.0%). During the 2014– the period before and after the large-scale invasion of Ukraine
2021 period, Esmarch’s tourniquet was most commonly used. by Russian forces. Data sources included records of all and
However, in 2022, it was mostly replaced by the Combat Ap- only casualties that reached a military field hospital or base
plication Tourniquet and similar systems (e.g., Sich, Dnipro). without information regarding casualties who received defin-
The duration of the tourniquet use ranged from 50 to 380 min- itive care or died earlier in the military medical care, received
utes (mean 205.9 [standard error 8.1] min), which prolonged definitive care, or died in a non-military facility. These data
ischemia in a significant number of cases. Limb amputations, do not include cases of torniquet application in all zones of
mainly due to extensive necrosis, were performed in 92 cases hostilities involving other hospital bases.
(3.7%). In addition to 101 deaths (4.0% of patients), 11 cases
of severe tourniquet syndrome were encountered. The limb was Collected data included limbs treated with tourniquets; the
salvaged in 9 cases (81.8%). Conclusion: Prompt triage and number, type, and duration of tourniquets per limb; the clinical
evacuation of injured combatants can save affected limbs, even course of limb injuries for which tourniquets were used; out-
when the duration of tourniquet use exceeds 2 hours. Tourni- comes of reconstructive limb interventions and amputations;
quet syndrome can be prevented using a hemostatic tourniquet. and the functional state of injured limbs during the 24-month
post-injury period.
Keywords: tactical medicine; limb injury; tourniquets; vascu-
lar surgery; Russo-Ukrainian war Statistical analysis of frequency and variance was conducted
using Statistica 14.0 software (TIBCO, USA). Means and their
standard errors were used for descriptive purposes. The null
hypothesis was rejected for p<.05.
Introduction
In modern tactical medicine, rapid tourniquet application for Results
severe limb injury is considered a crucial component of care
under fire. During tactical field care and evacuation, the use Serious injuries involving the main vessels increase the risk of
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of tourniquets for severe limb injuries represents appropriate death due to massive bleeding and the loss of a limb due to
standard of care. Tourniquet use to stop bleeding from severe critical ischemia and other post-ischemic complications in the
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limb injuries improves the chances of survival but is not de- near future. According to the Ukrainian practice (Figure 1),
finitive care. The duration of tourniquet use before receiving the tourniquets were used during medical evacuation mainly
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definitive care matters. 1–3 at the front line (50%–60%) in all cases of massive bleeding.
Up to 30%–40% of all cases were stabilized between 2 and
Several types and models of emergency tourniquets are com- 5km away from the contact line. Another 5%–10% of the
mercially available. However, the time from tourniquet appli- wounded ended up at the level of the reinforcement brigade at
cation to definitive care depends on multiple factors, including the base of the local civil hospitals (15–20km) or a field hospi-
the number of casualties needing care and the ease and dis- tal (35–50km). Only a small number of the wounded required
tance of evacuation to definitive care. Non-elastic strap and treatment in the deep rear at hospital bases.
*Correspondence to yuri.vorokhta@gmail.com
1 Col Igor M. Samarskyi is a Head of Vascular Surgery Department at the Military Medical Clinical Center of the Southern Region, Odesa,
Ukraine. Col Eduard M. Khoroshun is a Head of the Military Medical Clinical Center of the Northern Region, Kharkiv, Ukraine. Capt Yurii
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M. Vorokhta is a Head of Health Center at the army unit A1620, Ukraine.
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