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Plasma flow distal to tourniquet placement provides a physiological mechanism for tissue salvage.

ABSTRACT: Military literature has demonstrated the utility and safety of tourniquets in preventing mortality for some time, paving the way for increased use of tourniquets in civilian settings, including perioperatively to provide a bloodless surgical field. However, tourniquet use is not without risk and the subsequent effects of tissue ischemia can impede downstream rehabilitative efforts to regenerate and salvage nerve, muscle, tissue and bone in the limb. Limb ischemia studies in both the mouse and pig models have indicated not only that there is residual flow past the tourniquet by means of microcirculation, but also that recovery from tissue ischemia is dependent upon this microcirculation. Here we expand upon these previous studies using portable Near-Infrared Imaging to quantify residual plasma flow distal to the tourniquet in mice, pigs, and humans and leverage this flow to show that plasma can be supersaturated with oxygen to reduce intracellular hypoxia and promote tissue salvage following tourniquet placement. Our findings provide a mechanism of delivery for the application of oxygen, tissue preservation solutions, and anti-microbial agents prior to tourniquet release to improve postoperative recovery. In the current environment of increased tourniquet use, techniques which promote distal tissue preservation and limb salvage rates are crucial.

SUBMITTER: Busse E

PROVIDER: S-EPMC7752148 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Plasma flow distal to tourniquet placement provides a physiological mechanism for tissue salvage.

Busse Emily E Hickey Cheryl C Vasilakos Nicole N Stewart Kennon K O'Brien Fred F Rivera Jessica J Marrero Luis L Lacey Michelle M Schroll Rebecca R Van Meter Keith K Sammarco Mimi C MC

PloS one 20201221 12

Military literature has demonstrated the utility and safety of tourniquets in preventing mortality for some time, paving the way for increased use of tourniquets in civilian settings, including perioperatively to provide a bloodless surgical field. However, tourniquet use is not without risk and the subsequent effects of tissue ischemia can impede downstream rehabilitative efforts to regenerate and salvage nerve, muscle, tissue and bone in the limb. Limb ischemia studies in both the mouse and pi ...[more]

PMID: 33347516

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Project description:PurposeThe purpose of this study was to determine the effects of blood flow restriction (BFR) using a pneumatic tourniquet on CD34+ cells, platelets, white blood cells, neutrophils, lymphocytes, lactate, and glucose compared with standard exercise.MethodsFifteen healthy volunteers (8 males and 7 females, 28.6 ± 3.6 years old) who were able to perform the exercise sessions on a VersaClimber participated. Participants were randomized to undergo an experimental (EXP) occluded testing session using the pneumatic tourniquets on all 4 extremities and a control (CON) session. The exercise protocol concluded after 9 minutes or when participants reached a rating of perceived exertion of 20. Blood draws were performed before testing and immediately after the exercise session. Blood analysis consisted of complete blood counts as well as flow cytometry to measure peripheral CD34+ counts as a marker for hematopoietic progenitor cells (HPCs).ResultsA significant increase from before to after exercise values was observed in both the EXP and CON groups with CD34+, WBC counts, platelets, and lymphocytes; however, no differences existed between EXP and CON groups for any variable. CD34+ increased in the EXP (3.1 ± 1.6 vs. 4.3 ± 1.8 cells · L-1; P < .001) and CON (3.3 ± 1.9 vs. 4.4 ± 1.4 cells · L-1; P < .001) sessions. White blood cells also significantly increased in both the EXP (7.8 ± 1.4 vs. 11.8 ± 2.5 K · L-1 K · L-1; P < .001) and CON (7.5 ± 1.8 vs. 11.3 ± 3.0 K · L-1; P < .001) sessions. Platelets also increased in both the EXP (258.6 ± 52.5 vs. 309.9 ± 52.7 K · L-1; P < .001) and CON (263.1 ± 44.7 vs. 316.1 ± 43.9 K · L-1; P < .001) sessions, and conversely, a significant decrease in the average neutrophil counts in the EXP (mean difference = -13.7%; P < .001) and CON (mean difference = -13.2%; P < .001) sessions was observed. Lymphocyte counts in the EXP (mean difference = 22.8%; P < .001) and CON (mean difference = 19.3%; P < .001) sessions increased significantly.ConclusionsThere were no significant differences in systemic cellular responses when undergoing aerobic-based exercise with and without a pneumatic tourniquet system.Level of evidence2, prospective comparative study.

Dataset Information

Plasma flow distal to tourniquet placement provides a physiological mechanism for tissue salvage.

Publications

Plasma flow distal to tourniquet placement provides a physiological mechanism for tissue salvage.

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