A comparison study between the Hemorrhage-Arresting Lever-Operated (HALO) tourniquet and the Combat Action Tourniquet (CAT) for the management of exsanguinating extremity hemorrhage

Abstract

Introduction: Tourniquets have been demonstrated to reduce preventable deaths due to exsanguination. However, studies have suggested that the Combat Action Tourniquet (CAT®), a popular prehospital device, may have a 19-30 percent failure rate, thus prompting the creation of a new, lever-operated device for exsanguinating extremity hemorrhage. However, the efficacy of this device compared to the CAT has not been reported.

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 crossover observational study where an arterial hemorrhage was created on the right anterior, medial calf of a softly embalmed middle-aged female cadaver. A Kamoer UIP-CK15 continuous high-precision peristaltic pump was sutured to the femoral artery that measured the efflux of simulated bleeding. Participants were given manufacturer instructions for each tourniquet, randomized regarding which device to apply first, and queried about perceived ease of use and preference. All tourniquet applications were timed. Chi-square, McNemar test, t-test, and analysis of variance were used to compare groups. Factors significant in the univariate analysis were used to construct multivariate models of tourniquet success for each device type.

Results: Altogether, 135 participants were enrolled in the study, including 75 (55.5 percent) females, 13 (9.6 percent) ethnic minorities, 51 (37.7 percent) paramedics, 19 (14.1 percent) nurses, and 24 (17.7 percent) with prior military service. A total of 43 (31.8 percent) participants were able to achieve hemorrhage cessation with the HALO but not the CAT, compared with 6 (4.4 percent) of the participants who were able to achieve hemorrhage cessation with the CAT but not the HALO (p < .001). For participants who found the lever of the HALO easy to use, successful application of the HALO was 12.3 times more likely (odds ratio [OR] = 12.3; 95 percent confidence interval [CI]: 1.47-103.05). For those clinicians who applied the HALO properly compared with those who did not, hemorrhage cessation was 34.89 times more likely (OR = 34.89; 95 percent CI: 2.12-575.60). In contrast, there were no statistically significant predictors found for successful CAT application.

Conclusions: With minimal practice, 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.