Effectiveness of Congesting Cuffs ("Rotating Tourniquets") in Patients with Left Heart Failure

Congesting cuffs or “rotating tourniquets’ are often used to treat patients with acute pulmonary edema secondary to left heart failure. The purpose of this study was to evaluate the effectiveness of congesting cuffs in pooling blood in the extremities and decreasing pulmonary congesting pressures in patients with left heart failure and to define optimal congesting cuff pressures. Congesting cuffs on three extremities were inflated to 20, 40, 60 and 80 mm Hg in 16 patients with left heart failure and in 7 normal subjects. The extremities were elevated to collapse the veins before inflating the cuffs. The amount of venous pooling was measured with mercury-in-silastic strain gauge plethysmographs. Inflation of the cuffs produced significantly less venous pooling in patients with heart failure than in normal subjects. Decreases in right atrial pressure during inflation of the cuffs were also significantly less in the patients with heart failure than in the normal subjects. In patients with heart failure, pulmonary congesting pressure (left ventricular diastolic pressure or mean pulmonary arterial wedge pressure) averaged 24.2 ± 1.5 (SE) mm Hg in the control period and 24.6 ± 2.2, 22.9 ± 1.9, 23.2 ± 2.1 and 20.3 ± 1.6 mm Hg during inflation of the cuffs at 20, 40, 60 and 80 mm Hg, respectively. The decreases in pulmonary congesting pressure (PCP) were not significant (P> 0.05) at cuff pressures of 20, 40 and 60 mm Hg. Decreases in PCP were statistically significant at a cuff pressure of 80 mm Hg, but only 6 of 16 patients had decreases greater than 4 mm Hg. The results suggest that in patients with heart failure the effectiveness of congesting cuffs is limited by decreases in venous distensibility which are characteristic of heart failure.