Why the lungs became a target organ due to ischemic-reperfusion syndrome of the limb, caused by the use of haemostatic tourniquet

Nataliya Volotovska

DOI: http://dx.doi.org/10.12775/JEHS.2020.10.06.021


Much attention has been paid to the ambiguous effects of the tourniquets and hemostatic bandages - namely the local and systemic consequences of planned operations, as well as the changes that occur after the cessation of bleeding from a wounded limb on the battlefield. However, there is still no consensus on the ischemic-reperfusion syndrome (IRS). Aim. Detect changes in the activity of lipid peroxidation in lung tissue on the background of experimental modifications of IRS. For this goal 260 male white rats aged 5-5.5 months were divided into 5 experimental groups: 1) EG1 - imposition of the tourniquet on the thigh for 2 h; 2) EG2 - modeling of venous blood loss in the amount of 40% of the volume of circulating blood; 3) EG3 - a combination of hemostatic tourniquet and blood loss 4) EG4 - mechanical injury to the thigh bone 5) a combination of hemostatic tourniquet and mechanical trauma. The biochemical study in 10 % lung homogenate was performed by reacting of peroxidation derivatives with thiobarbituric acid. Conclusions. It was found that each of these types of intervention caused the activation of lipid peroxidation in the lungs. The peculiarities of the reaction were such increase of this rate, which was the highest on the background of blood loss combined with the use of a tourniquet. However, the concentration of malonic dialdehyde was higher in the group where the imposition of the tourniquet was combined with mechanical trauma, compared with isolated mechanical trauma of the thigh. This has shown the role of the tourniquet as a factor that complicated the course of traumatic disease due to ischemic reperfusion.


ischemia-reperfusion syndrome; lungs; trauma; blood loss; hemostatic tourniquet; lipid peroxidation

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Travmaticheskaya bolezn i ee oslojneniya (2004). Pod red. S.A.Selezneva, S.F. Bagnenko, Yu.B. Shapota, A.A., Kuryigina.- SPb, «Politehnika» [Traumatic disease and its complications], 414 p [in Russian].

Matvieienko M, Baranova N, Matvieienko S, Kozlova T, Gryshchenko A, Sukesh A. (2019). Аnalysis of acute and early periods complications of traumatic disease in severe polytrauma. The Journal of V. N. Karazin Kharkiv National University, Series.;Medicine;38:49-55.


Kalinkin OG. (2013). Travmaticheskaya bolezn [Traumatic disease and its complications]. Travma – Trauma, 14(3), 59-65 [in Russian].

Shpachenko NN, Zolotuhin SE, Kravchenko AV, Titov YuD, Shtutin AA. (2017. Periodizatsiya travmaticheskoy bolezni na sovremennom etape i aspektyi prognozirovaniya ee ishodov [Periodization of a traumatic disease at the present stage and aspects of predicting its outcomes]. Travmatologiya, ortopediya i voennaya meditsina – Traumatology, orthopedics and military medicine, 1, 71-77 [in Russian].

Obelchak IS, Bokeriya LA, Voynovskiy AE, Akimov AV. (2012). Multispiralnaya kompyuternaya tomografiya v diagnostike ognestrelnyih povrezhdeniy magistralnyih sosudov [Multispiral computed tomography in the diagnosis of gunshot injuries of the big vessels]. Radiologiya-praktika – Practice radiology, 5, 109-116 [in Russian].

Wild H, Stewart BT, LeBoa C, Stave CD, Wren SM. (2020). Epidemiology of Injuries Sustained by Civilians and Local Combatants in Contemporary Armed Conflict: An Appeal for a Shared Trauma Registry Among Humanitarian Actors. World J Surg, 44(6):1863‐1873. doi:10.1007/s00268-020-05428-y

Nerlander MP, Haweizy RM, Wahab MA, Älgå A, von Schreeb J. (2019). Epidemiology of Trauma Patients from the Mosul Offensive, 2016-2017: Results from a Dedicated Trauma Center in Erbil, Iraqi Kurdistan. World J Surg, 43(2):368‐373. doi:10.1007/s00268-018-4817-1

Gumanenko EK, Samohvalov IM (2011) Voenno-polevaya hirurgiya lokalnyih voyn i vooruzhennyih konfliktov: rukovodstvo dlya vrachey [Field surgery

Local Wars and Armed Conflict: A Guide for Physicians]– M.: IG «Geotar-Media»:135-139, 472-478 [in Russian].

Khomenko IP, Verba AV, Khoroshun EM, Khomenko IP. (2016). Nedoliky ta dosiahnennia v likuvanni poranenykh i travmovanykh v umovakh ATO [Shortcomings and achievements in the treatment of wounded and injured in the ATO] Medychne zabezpechennia antyterorystychnykh operatsii: naukovo-orhanizatsiini ta medyko-sotsialni aspekty: zbirnyk naukovykh prats za zah. red. akademikiv NAN Ukrainy Tsymbaliuka V. I. ta Serdiuka A. M. – Medical support of anti-terrorist operations: scientific-organizational and medical-social aspects: a collection of scientific works for general. ed. Academicians of the NAS of Ukraine Tsymbalyuk VI and Serdyuk AM – K. : DP «NVTs «Priorytety», 123-124

Champion HR, Bellamy RF, Roberts CP, Leppaniemi A. (2003). A profile of combat injury. J Trauma, 54(5 Suppl), 13-19.


Zietlow JM, Zietlow SP, Morris DS, Berns KS, Jenkins DH. (2015). Prehospital use of hemostatic bandages and tourniquets: translation from military experience to implementation in civilian trauma care. J Spec Oper Med, 15, 48-53

ANZCOR Guideline 9.1.1 – First Aid for Management of Bleeding Australian Resuscitation Council. – July 2017:7 p.

Bulger EM, Snyder D, Schoelles K, et al. (2014). An evidence-based prehospital guideline for external hemorrhage control: American College of Surgeons Committee on Trauma. Prehosp Emerg Care, 18(2):163-173.



Mathru M, Dries DJ, Barnes L, Tonino P, Sukhani R, Rooney MW. Tourniquet-induced exsanguination in patients requiring lower limb surgery. An ischemia–reperfusion model of oxidant and antioxidant metabolism. Anesthesiology 1996;84:14–22

Wakai A, Wang JH, Winter DC, Street JT, O'Sullivan RG, Redmond HP. (2001). Tourniquet-induced systemic inflammatory response in extremity surgery. J Trauma, 51(5), 922‐926. doi:10.1097/00005373-200111000-00016

Lin LN, Wang LR, Wang WT, et al. Ischemic preconditioning attenuates pulmonary dysfunction after unilateral thigh tourniquet-induced ischemia-reperfusion [published correction appears in Anesth Analg. 2010 Nov;111(5):1307]. Anesth Analg. 2010;111(2):539‐543. doi:10.1213/ANE.0b013e3181e368d2

Weber NC, Zuurbier CJ, Hollmann MW. (2018). Remote ischaemic preconditioning of the lung: from bench to bedside-are we there yet?. J Thorac Dis, 10(1), 98‐101.

doi:10.21037/jtd.2017.12.75 (немає цього джерела)

Aslan T, Turer MD, Joseph A, Hill MD. (2010). Pathogenesis of myocardial ischemia-reperfusion injury and rationale for therapy. The American Journal of Cardiology, 106, 3, 360-368.

Zhang JA., Zhang JB, Yu PC, Chen MD, Peng OE, Wang ZF, Dong NA. (2017). Remote ischaemic preconditioning and sevoflurane postconditioning synergistically protect rats from myocardial injury induced by ischemia and reperfusion partly via inhibition TLR4/MyD88/NF-κB Signaling Pathway. Cellular Physiology and Biochemistry, 41, 22-32.

Teoh NC, Farrell GC. (2003). Hepatic ischemia reperfusion injury: Pathogenic mechanisms and basis for hepatoprotection. Journal of Gastroenterology and Hepatology, 18 (8), 891-902.

Inauen W, Suzuki M, Granger DN. (1989). Mechanisms of cellular injury: potential sources of oxygen free radicals in ischemia/reperfusion. Microcirculation, endothelium, and lymphatics, 5 (3-5), 143-155.

Rochette L, Maupoil V. (1992). Free radicals, lipid peroxidation and muscular ischemia. Comptes Rendus des Seances de la Societe de Biologie, 186 (3), 252-262.

Karg E, Németh I, Virág G, Mészáros T, Boda D, Pintér S. (1997). Oxidative stress induced by bloodless limb surgery on humans. Eur J Clin Invest, 27(12):984‐991.


Leurcharusmee P, Sawaddiruk P, Punjasawadwong Y, Chattipakorn N, Chattipakorn SC. (1918). The Possible Pathophysiological Outcomes and Mechanisms of Tourniquet-Induced Ischemia-Reperfusion Injury during Total Knee Arthroplasty. Oxid Med Cell Longev, 8087598. Published 2018 Nov 5. doi:10.1155/2018/8087598

Barrington JH, Chrismas BCR, Gibson OR, et al. (2017). Hypoxic Air Inhalation and Ischemia Interventions Both Elicit Preconditioning Which Attenuate Subsequent Cellular Stress In vivo Following Blood Flow Occlusion and Reperfusion. Front Physiol, 8:560


Tapuria N, Kumar Y, Habib MM, Abu Amara M, Seifalian AM, Davidson BR. (2008). Remote ischemic preconditioning: a novel protective method from ischemia reperfusion injury--a review. J Surg Res, 150(2):304‐330. doi:10.1016/j.jss.2007.12.747

Koca K, Yurttas Y, Cayci T, et al. (2011). The role of preconditioning and N-acetylcysteine on oxidative stress resulting from tourniquet-induced ischemia-reperfusion in arthroscopic knee surgery [published correction appears in J Trauma. 2012 Feb;72(2):538. Hanci, Vokan [corrected to Hanci, Volkan]]. J Trauma, 70(3):717‐723. doi:10.1097/TA.0b013e3181f30fb0

Pedowitz RA. Tourniquet-induced neuromuscular injury. (1991). A recent review of rabbit and clinical experiments. Acta Orthop Scand Suppl, 245:1-33.

Seekamp A, Jochum M, Ziegler M, van Griensven M, Martin M, Regel G. (1998). Cytokines and adhesion molecules in elective and accidental trauma-related ischemia/reperfusion. J Trauma, 44(5):874‐882.


Hildebrand F, Pape HC, Krettek C. (2005). Die Bedeutung der Zytokine in der posttraumatischen Entzündungsreaktion [The importance of cytokines in the posttraumatic inflammatory reaction]. Unfallchirurg, 108(10):793‐803. [in German].


Almahmoud K, Abboud A, Namas RA, et al. (2019). Computational evidence for an early, amplified systemic inflammation program in polytrauma patients with severe extremity injuries. PLoS One, 14(6):e0217577. Published 2019 Jun 4.


Lin L, Wang L, Bai Y, et al. (2010). Pulmonary gas exchange impairment following tourniquet deflation: a prospective, single-blind clinical trial. Orthopedics. 33(6):395. Published 2010 Jun 9. doi:10.3928/01477447-20100429-15

Tsymbaliuk, H.Yu. (2018). Stan dobovoho diurezu nyrok v umovakh ishemichno-reperfuziinoho syndromu kintsivok, travmy orhaniv cherevnoi porozhnyny, usklad¬nenoi hipovolemichnym shokom, ta yikh poiednannia u rannomu periodi travmatychnoi khvoroby [Daily urine renal state under ischemic-reperfusion syndrome of limbs, abdominal injury with hypovolemic shock and their combination in the early period of traumatic disease]. Zdobutky klinichnoi i eksperymentalnoi medytsyny – Achievements of Clinical and Experimental Medicine, 3 (35), 163-169 [in Ukrainian].

Grinev M. V., Grinev K.M. (2010). Tsitokin-assotsiirovannyie narusheniya mikrotsirkulyatsii (ishemicheski-reperfuzionnyiy sindrom) v geneze kriticheskih sostoyaniy [Cytokine-associated microcirculatory disorders (ischemic reperfusion syndrome) in the genesis of critical conditions

]. Hirurgiya. Zhurnal im. N.I. Pirogova, 6, 36-39. Retrieved from: https://www.mediasphera.ru/issues/khirurgiya-zhurnal-im-n-i-pirogova/2010/12/030023-120720101213 [in Russian].

Drozdova GA, Samigullina AF, Nurgaleeva EA, Sorokin AA. (2015). Reperfuzionnoe endotoksinovoe povrezhdenie organa zreniya v eskperimente [Reperfusion endotoxin damage to the organ of vision in experiment]. Kazanskiy meditsinskiy zhurnal – Kazan Medical Journal, 96(5), 811-814 [in Russian].

Volotovska NV, Kashchak TV (2019). Antioxidant enzymes activity in experimental ischemia-reperfusion injury International Journal of Medicine and Medical Research, 5(1), 84-90.

doi 10.11603/IJMMR.2413-6077.2019.1.1.10308.

Kolesova OE, Markin AA, Fedorova TN. (1984). Perekisnoe okislenie lipidov i metodyi opredeleniya produktov lipoperoksidatsii v biologicheskih sredah [lipid peroxidation and methods for determination of lipid peroxidation products in biological liquids]. Laboratornoe delo -Laboratory science, 9, 540-546. [in Russian].

Nishiguchiab M, Tacamura N, Abeb Y, Kono M, Shindo H, Aoyagi K. (2005)

Pilot study on the use of tourniquet: a risk factor for pulmonary thromboembolism after total knee arthroplasty? Thrombosis Research 115(4), 271-276

https://doi.org/10.1016/j.thromres.2004.08.018Get rights and content https://www.sciencedirect.com/science/article/abs/pii/S004938480400461X

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