Tourniquet Syndrome

By | June 10, 2022

Tourniquet syndrome is a life-threatening complication that can occur after reperfusion of a previously ligated body part. It can include shock, cardiac arrhythmias, and irreversible kidney damage.

What is Tourniquet Syndrome?

Tourniquet syndrome is also known as reperfusion trauma. It occurs when a part of the body that has had reduced or no blood flow for several hours is reconnected to the systemic system. For slang arm, please visit

The tolerance time during which ischemia (reduced blood flow) can persist without subsequently causing tourniquet syndrome is about 6 hours on average. However, the exact tolerance time varies greatly from person to person.

Tourniquet syndrome takes its name from the tourniquet ligature, a surgical device formerly used to tie off large vessel trunks.


The tourniquet syndrome initially seems paradoxical: the layman intuitively thinks that the restored blood flow to a previously undersupplied part of the body is not threatening but saving.

The problem is that prolonged ischemia in the ligated limb throws the metabolism off balance. Through reperfusion, pathological metabolic products are washed into the rest of the organism and can cause damage there. In particular, over- acidification (acidosis) occurs in the area affected by a lack of oxygen due to the increased formation of lactate.

Oxygen radicals are increasingly produced, which can cause cell damage. After a certain time, rhabdomyolysis sets in, ie the breakdown of striated muscle tissue. Dying cells release potassium and myoglobin, among other things. The particles released in the extracellular space cause edema, which in turn causes additional damage to the surrounding tissue due to increased pressure.

Potassium is primarily responsible for the danger to life in tourniquet syndrome : If it is distributed throughout the organism after reperfusion and causes systemic hyperkalemia, there is a risk of cardiac arrhythmia and even cardiac arrest.

Typical Symptoms & Signs

  • necrosis, ischemia
  • hyperkalemia
  • hyperacidity (acidosis)
  • cardiac arrhythmias
  • kidney failure
  • Circulatory arrest (cardiovascular failure)

Diagnosis & History

The fact that a tourniquet syndrome is imminent can already be seen from the limb that is still tied off: the progressive tissue damage is noticeable through swelling, reddening and overheating. After reperfusion, there is almost always generalized edema and a resulting volume deficiency shock with the typical signs of shock such as paleness, drop in blood pressure and increased heart rate.

The shock index is positive. Pain and sensory and motor deficits appear on the previously tied extremity. The diagnosis of tourniquet syndrome is supported by laboratory findings: the patient’s blood shows severe metabolic acidosis and increased potassium levels. The released myoglobin can also cause kidney damage up to acute kidney failure. A dark brown coloration of the urine and myoglobinuria indicate a threat to the kidneys.


Tourniquet syndrome is already a serious complication that, if left untreated, can lead to death. Typical sequelae of the syndrome include necrosis and ischemia. There is a risk that the tied body part will die off completely and have to be amputated. Such necrosis is usually associated with serious cardiovascular problems and circulatory disorders.

It can also lead to kidney failure and, in the worst case, to cardiac arrest. Acidosis, too much acid in the blood, can also occur, which is associated with low blood pressure, headaches, shortness of breath and hyperventilation. Reperfusion can be followed by the development of edema, usually associated with volume depletion shock and severe shock symptoms such as hypotension and tachycardia.

Tourniquet syndrome is always associated with pain and sensory and motor deficits. Treating the syndrome also carries risks. Dialysis carries the risk of further cardiovascular problems. Infections or injuries at the site of the puncture cannot be ruled out either.

In most cases, the patient is prescribed relatively strong painkillers, which can lead to side effects. Allergy sufferers can experience an allergic reaction up to and including anaphylactic shock. Interactions with other medications cannot be ruled out either.

When should you go to the doctor?

Tourniquet syndrome is a medical emergency. The affected person must be treated immediately by a doctor. Symptoms of necrosis or hyperkalemia indicate reperfusion trauma and require investigation. The syndrome can occur due to previous medical conditions or in connection with an accident or fall. If there is a suspicion that an extremity is not getting enough blood, either the blood flow must be restored or a doctor must be consulted. Symptoms such as swelling or redness indicate reperfusion.

Generalized edema and typical signs of shock such as pallor, drop in blood pressure or increased heart rate appear later. A dark brown coloration of the urine indicates imminent kidney damage as a result of released myoglobins. The symptoms mentioned are clear warning signs that must be clarified immediately. The right contact person is your family doctor or, in the case of acute symptoms, the emergency services. The patient must be treated in a hospital and, depending on the cause, consult other specialists such as orthopedists or cardiologists.

Treatment & Therapy

Treatment of tourniquet syndrome initially focuses on controlling the life-threatening hypovolemic shock and cardiac arrhythmia. Metabolic acidosis can be counteracted by hyperventilation ; it may also be buffered by bicarbonate.

In order to preserve the kidney, massive volume administration and, under certain circumstances, hemofiltration may be necessary. The success of the treatment depends crucially on how early the reperfusion of the affected body part takes place. If the ischemia lasts too long and the tissue damage is too massive, only amputation can prevent the death of the patient.

With therapy within the first 4 hours after ischemia, the amputation rate is only four percent; after at least 12 hours of ischemia, amputation has to be carried out in 30 to 50 percent of cases. Thanks to modern intensive care measures, the chances of surviving tourniquet syndrome have increased significantly, but the threat of this clinical picture should not be underestimated. In the case of tourniquet syndrome after ischemia of the lower extremities, the mortality rate in the literature is still given as up to 20 percent.


The best prevention of tourniquet syndrome is to never tie off any part of the body for longer than absolutely necessary. If ligation is unavoidable due to the risk of blood loss, it is helpful to cool the affected limb before reperfusion – this reduces certain enzyme activities and allows fewer harmful metabolites to form. In long-term ischemia, amputation is the only way to protect the residual organism from tourniquet syndrome.

You can do that yourself

In certain cases, self-treatment can heal or alleviate the symptoms. Tried and tested recipes that have been handed down over generations save you from having to consult a doctor. However, this form of therapy is not suitable for life-threatening conditions such as tourniquet syndrome. Acute medical treatment is unavoidable for this disease. Intensive medical monitoring follows regularly. If the extremity cannot be saved, it usually has to be amputated. Patients then continue to live with functional limitations.

Those affected can only prevent it to a limited extent and thus rule out the cause of tourniquet syndrome. You must ensure that no part of the body is tied off longer than necessary. Tourniquet syndrome poses a great danger, especially in small children. Because they cannot articulate themselves sufficiently, parents cannot identify the actual cause of the pain. Even hair caught in the socks can cause the loss of a toe.

Tourniquet syndrome sometimes raises suspicions of abuse. A strangulation can result from a crime. Those affected should therefore investigate the causes of tourniquet syndrome extensively and contact the local police station if they suspect it.

Tourniquet Syndrome