The 50 original articles included in this qualitative , systematic review revealed that the recommendations " Tourniquet " of the DGAI published in 2016 are mostly still up to date despite an inhomogeneous study situation .
INTRODUCTION The effectiveness of a  tourniquet  in the case of life-threatening hemorrhages of the extremities is well recognized and led to the recommendations on " Tourniquet " of the German Society of Anaesthesiology and Intensive Care ( DGAI ) in 2016 .
The aim of this systematic review was to re-evaluate the current medical literature in relation to the published DGAI recommendations .
The American Association for the Surgery of Trauma PROspective Observational Vascular Injury Treatment (PROOVIT) registry: Multicenter data on modern vascular injury diagnosis, management, and outcomes
BACKGROUND There is a need for a prospect i ve registry design ed to capture trauma-specific , in-hospital , and long-term outcomes related to vascular injury . METHODS The American Association for the Surgery of Trauma PROspect i ve Vascular Injury Treatment ( PROOVIT ) registry was used to collect demographic , diagnostic , treatment , and outcome data on vascular injuries . RESULTS A total of 542 injuries from 14 centers ( 13 American College of Surgeons – verified Level I and 1 American College of Surgeons – verified Level II ) have been captured since February 2013 . The majority of patients are male ( 70.5 % ) , with an Injury Severity Score ( ISS ) of 15 or greater among 32.1 % . Penetrating mechanisms account for 36.5 % . Arterial injuries to the head/neck ( 26.7 % ) , thorax ( 10.4 % ) , abdomen/pelvis ( 7.8 % ) , upper extremity ( 18.4 % ) , and lower extremity ( 26.0 % ) were identified , along with 98 major venous injuries . Hard signs of vascular injury , including hypotension ( systolic blood pressure < 90 mm Hg , 11.8 % ) , were noted in 28.6 % . Prehospital tourniquet use for extremity injuries occurred in 20.2 % ( 47 of 233 ) . Diagnostic modalities included exploration ( 28.8 % ) , computed tomographic angiography ( 38.9 % ) , duplex ultrasound ( 3.1 % ) , and angiography ( 10.7 % ) . Arterial injuries included transection ( 24.3 % ) , occlusion ( 17.3 % ) , partial transection/flow limiting defect ( 24.5 % ) , pseudoaneurysm ( 9.0 % ) , and other injuries including intimal defects ( 22.7 % ) . Nonoperative management was undertaken in 276 ( 50.9 % ) , with failure in 4.0 % . Definitive endovascular and open repair were used in 40 ( 7.4 % ) and 126 ( 23.2 % ) patients , respectively . Damage-control maneuvers were used in 57 ( 10.5 % ) , including ligation ( 31 , 5.7 % ) and shunting ( 14 , 2.6 % ) . Reintervention of initial repair was required in 42 ( 7.7 % ) . Amputation was performed in 7.7 % of extremity vascular injuries , and overall hospital mortality was 12.7 % . Follow-up ranging from 1 month to 7 months is available for 48 patients via a variety of modalities , with reintervention required in 1 patient . CONCLUSION The PROOVIT registry provides a contemporary picture of the management of vascular injury . This re source promises to provide needed information required to answer questions about optimal diagnosis and management of these patients —including much needed long-term outcome data . LEVEL OF EVIDENCE Epidemiologic study , level
The 50 original articles included in this qualitative , systematic review revealed that the recommendations " Tourniquet " of the DGAI published in 2016 are mostly still up to date despite an inhomogeneous study situation .
INTRODUCTION The effectiveness of a  tourniquet  in the case of life-threatening hemorrhages of the extremities is well recognized and led to the recommendations on " Tourniquet " of the German Society of Anaesthesiology and Intensive Care ( DGAI ) in 2016 .
The aim of this systematic review was to re-evaluate the current medical literature in relation to the published DGAI recommendations .