The time limit of 120 minutes for the continuous use of HemaShock® is based on the standard practice in orthopedic surgery and with the use of emergency/combat tourniquet.
In most instances this should be sufficient time to evacuate the patient to definitive care in a medically controlled environment, to establish the other measures needed to stabilize the patient (diagnostic tests, Surgical intervention if needed, IV fluids, blood, vasoactive drugs, antibiotics, steroids and the like), and to stabilize the patient’s hemodynamics.
However, sometimes 120 minutes are not enough, due to a variety of clinical and/or logistical reasons. In addition, the requirement that the HemaShock® be removed from the patient gradually, in small steps, while monitoring his/her blood pressure and other indicators of hemodynamics, will sometimes require more time. The question of “buying” additional time becomes crucial.
Extending the tourniquet time is discouraged.
Although the literature, including recommendations by authorities such as Mr. Leslie Klenerman from the UK, indicates that the use of a tourniquet for more than 2 hours (up to three hours) is not associated with irreversible injury to the limb, we do not recommend doing so, unless it is a clear case of “Life vs. Limb” condition with an explicit decision made by a competent physician.
The alternative is to apply a “rotating tourniquet” approach. It’s not unlike the old rotating (venous) tourniquet used in cases of severe Congestive Heart Failure before positive pressure ventilation became widely available. We propose removing HemaShock® from one leg while applying two child-size HemaShock® devices to the arms at about 90 minutes after onset.
About 30 minutes, re-apply a HemaShock® on the free leg while removing the HemaShock® from the second leg and from one or both arms. This process can be repeated while maintaining a very careful log of the duration of each limb blood flow occlusion.
This method can extend the duration of HemaShock® application for several hours if transport is very long or for other reasons.