Assessment of the effectiveness and risks of using tourniquets in the Armed Forces of Ukraine during hostilities in Ukraine

Abstract

Relevance. Massive bleeding remains one of the leading causes of death among military personnel in armed conflicts, which leads to a constant need to improve the means of temporary bleeding control. The Combat Application Tourniquet (CAT) continues to be the standard in tactical medicine due to its proven clinical effectiveness, high speed of application and reliability in combat. Its use significantly reduces mortality in injuries with critical bleeding from the extremities, especially at the pre-hospital stage of medical care. Objective: to analyse the impact of the use of tourniquets (tourniquets) by military personnel in cases of massive/critical bleeding, traumatic amputations of limbs, and to assess the timeliness of the conversion in the world and in Ukraine. Particular attention is paid to the rationale for the expediency and inexpediency of using tourniquets, the duration of their application, as well as the study of possible complications associated with their excessive or untimely use during intense hostilities and delays in evacuating the wounded. Materials and methods. The work was carried out through a systematic review, meta-analysis, content analysis of articles in the scientometric databases Scopus, PubMed, ResearchGate. The literature search was carried out using the following keywords: ‘tourniquet’, ‘stop the bleeding’. The study included descriptions of clinical cases of tourniquets applied by the Armed Forces of Ukraine, retrospective analyses and literature reviews. The study was conducted on the basis of one surgical hospital (ROLE 2) for the period April -May in 2024 and April-May in 2025, n=135 servicemen. After reviewing the articles and reading their full texts, 8 sources were selected. The search for the use of tourniquets and complications was conducted for the period 2012-2025. In the period April -May in 2024 and April-May in 2025 the use of temporary stop of critical bleeding, the appropriateness of use, duration and risks of complications in 135 servicemen who were in the combat zone were analysed. Conclusions The duration of haemostasis in a significant number of cases exceeds 2 hours (compared to 2024/2025, it decreased by 10%), and the duration of tourniquets exceeds 3 hours (compared to 2024/2025, it increased by 5.0%), which indicates a prolonged evacuation of the wounded as a result of intense hostilities, which in turn increases the risk of ischaemic complications and requires careful clinical monitoring. In 70% of cases, one tourniquet is enough to stop the bleeding, while in 25% of situations, two or more tourniquets are required, which indicates the more severe nature of the wounds caused by the modernisation and increased destructive power of modern weapons. Ischaemic complications are recorded in almost half of the cases, the main reason for which is the prolonged application of a tourniquet.