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 .
Postischemic conditioning does not reduce muscle injury after tourniquet-induced ischemia-reperfusion injury in rats.
BACKGROUND The widespread application of tourniquets has reduced battlefield mortality related to extremity exsanguinations . Tourniquet-induced ischemia-reperfusion injury ( I/R ) can contribute to muscle loss . Postischemic conditioning ( PostC ) confers protection against I/R in cardiac muscle and skeletal muscle flaps . The objective of this study was to determine the effect of PostC on extremity muscle viability in an established rat hindlimb tourniquet model . METHODS Rats were r and omly assigned to  PostC-1 , PostC-2 , or no conditioning ischemic groups ( n = 10 per group ) .  Postischemic conditioning , performed immediately after tourniquet release , consisted of four 15-second cycles ( PostC-1 ) or eight 15-second cycles ( PostC-2 ) of alternating occlusion and perfusion of hindlimbs . Twenty-four hours later , muscles were excised . The primary end points were muscle edema and viability ; secondary end points were histologic and markers of oxidative stress . RESULTS Ischemia-reperfusion injury decreased viability in all tourniquet limbs , but viability was not improved in either PostC group . Likewise , I/R result ed in substantial muscle edema that was not reduced by PostC. The predominant histologic feature was necrosis , but no significant differences were found among groups . Markers of oxidative stress were increased similarly among groups after I/R , although myeloperoxidase activity was significantly increased only in the no conditioning ischemic group . A protective effect from PostC was not observed in our model suggesting that PostC was not effective in reducing I/R skeletal muscle injury or any benefits of PostC were not sustained for 24 hours when tissues were assessed . CONCLUSION These negative findings are pertinent as the military investigates different strategies to extend the safe time for tourniquet application
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 .