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A Comparison Study between the Hemorrhage Arresting Lever-Operated (HALO) Tourniquet and the Combat Action Tourniquet (CAT) for the Management of Exsanguinating Extremity Hemorrhage

Author: Ginny Renkiewicz, PhD, MHS, Paramedic, FAEMS | |

Associate Authors:

Introduction

Studies have suggested that the Combat Action Tourniquet (CAT) may have a 21% failure rate, which is likely due to difficulties using the windlass, one-handed application, or achieving maximum tension. Such issues have prompted the creation of a new, lever-operated device for exsanguinating extremity hemorrhage.

Objective

To determine efficacy and ease of use of the Hemorrhage-Arresting Lever Operated (HALO) tourniquet compared to the
CAT.

Methods

This was a prospective observational study where an arterial hemorrhage was created on the right anterior, medial calf of a softly embalmed middle-aged female cadaver. A Kamoer VIP–CK15 continuous high-precision peristaltic pump was sutured to the femoral artery by a trauma surgeon that measured the efflux of simulated bleeding. All tourniquet applications were timed. Participants were given manufacturer instructions for each device, randomized with which tourniquet to apply first, and queried about perceived ease of use and preference. Chi-square, t-test, and ANOVA were used to compare groups.

Results

Altogether, 130 participants were enrolled in the study resulting in 260 tourniquet applications. Among those, 75 (57.7%) were female, 13 (12.3%) were minorities, 51 (39.2%) were paramedics, 19(14.6%) were nurses, and 24 (18.5%) were prior military. The proportion of females who experienced difficulty using the windlass on the CAT was higher compared to men (34.7% vs 14.5%; P = 0.008); this finding was not significant with the lever on the HALO. Paramedics were 2.77 times
more successful ceasing hemorrhage using the HALO compared to the CAT (52.4% vs 18.9%). There were no significant
differences in application time (in seconds) between those who found the CAT to be easier than the HALO (0.32 ± 0.15 vs 0.39 ± 0.45; P = 0.804). However, those who preferred the HALO applied it in half the time (0.51 ± 0.40 vs 0.25 ± 0.14; P = 0.049). Prior military servicemembers were able to achieve hemorrhage cessation at a rate 2.08 times higher with the HALO than with the CAT (59.7% vs 28.6%), and 71.4% of combat medics felt the HALO was easier to apply. Average volume losses (in mLs) between the HALO and CAT were negligible (300.95 ± 186.29 vs 280.05 ± 171.24).

Conclusions

With minimal training, results suggest that the HALO tourniquet may be as effective and easier to use than the CAT tourniquet in the presence of exsanguinating lower extremity hemorrhage. Additional research is required for alternate locations and patient types.