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 .
Training and Assessing Critical Airway, Breathing, and Hemorrhage Control Procedures for Trauma Care: Live Tissue Versus Synthetic Models
INTRODUCTION Optimal teaching and assessment methods and models for emergency airway , breathing , and hemorrhage interventions are not currently known . The University of Minnesota Combat Casualty Training consortium ( UMN CCTC ) was formed to explore the strengths and weaknesses of synthetic training models ( STMs ) versus live tissue ( LT ) models . In this study , we compare the effectiveness of best in class STMs versus an anesthetized caprine ( goat ) model for training and assessing seven procedures : junctional hemorrhage control , tourniquet ( TQ ) placement , chest seal , needle thoracostomy ( NCD ) , nasopharyngeal airway ( NPA ) , tube thoracostomy , and cricothyrotomy ( Cric ) . METHODS Army combat medics were r and omized to one of four groups : 1 ) LT trained-LT tested ( LT-LT ) , 2 ) LT trained-STM tested ( LT-STM ) , 3 ) STM trained-LT tested ( STM-LT ) , and 4 ) STM trained-STM tested ( STM-STM ) .  Participants trained in small groups for 3 to 4 hours and were evaluated individually . LT-LT was the " control " to which other groups were compared , as this is the current military predeployment st and ard . The mean procedural scores ( PSs ) were compared using a pairwise t-test with a Dunnett 's correction . Logistic regression was used to compare critical fails ( CFs ) and skipped tasks . RESULTS There were 559 subjects included . Junctional hemorrhage control revealed no difference in CFs , but LT-tested subjects ( LT-LT and STM-LT ) skipped this task more than STM-tested subjects ( LT-STM and STM-STM ; p < 0.05 ) , and STM-STM had higher PSs than LT-LT ( p < 0.001 ) . For TQ , both STM-tested groups ( LT-STM and STM-STM ) had more CFs than LT-LT ( p < 0.001 ) and LT-STM had lower PSs than LT-LT ( p < 0.05 ) . No differences were seen for chest seal . For NCD , LT-STM had more CFs than LT-LT ( p = 0.001 ) and lower PSs ( p = 0.001 ) . There was no difference in CFs for NPA , but all groups had worse PSs versus LT-LT ( p < 0.05 ) . For Cric , we were underpowered ; STM-LT trended toward more CFs ( p = 0.08 ) , and STM-STM had higher PSs than LT-LT ( p < 0.01 ) . Tube thoracostomy revealed that STM-LT had higher CFs than LT-LT ( p < 0.05 ) , but LT-STM had lower PSs ( p < 0.05 ) . An interaction effect ( making the subjects who trained and tested on different models more likely to CF ) was only found for TQ , chest seal , and Cric ; however , of these three procedures , only TQ demonstrated any significant difference in CF rates . CONCLUSION Training on STM or LT did not demonstrate a difference in subsequent performance for five of seven procedures ( junctional hemorrhage , TQ , chest seal , NPA , and NCD ) . Until STMs are developed with improved anthropomorphic and tissue fidelity , there may still be a role for LT for training tube thoracostomy and potentially Cric . For assessment , our STM appears more challenging for TQ and potentially for NCD than LT . For junctional hemorrhage , the increased " skips " with LT may be explained by the differences in anatomic fidelity . While these results begin to uncover the effects of training and assessing these procedures on various models , further study is needed to ascertain how well performance on an STM or LT model translates to the human model
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 .