[[100 Welcome to Outlines of Technique in Cardiac Surgery]] # Rumel Tourniquet ![[William Ray Rumel.png]] William Ray Rumel was born in 1911 in Salt Lake City. He grew up on his family's dairy farm outside of the city. He completed his undergraduate education and first two years of medical school at the University of Utah, and he subsequently transferred to Northwestern University to finish his medical degree. He completed his residency in 1938 after training at Cook County Hospital and St. Luke's Hospital in Chicago. After residency, he pursued training in chest surgery at the Lahey Clinic in Boston under the supervision of Dr. Richard Overholt prior to returning to his home state to begin his career as a cardiac and thoracic surgeon. He recorded numerous accomplishments over the course of his career, including the foundation of the first dedicated cardio-thoracic hospital unit and as a pioneer in mitral commissurotomy. He used his home workshop in the development of new surgical instruments. He created the Rumel Dissecting Forceps and, most famously, the Rumel Tourniquet. Dr. Rumel completed the rest of his career in Utah, remaining clinically active until 7 months prior to his death in 1977. He is most often remembered for his development of the Rumel Tourniquet, which is still used in most cardiac procedures to this day. The idea was sparked by his experience watching a colleague perform a mitral valve repair. Other surgical pioneers (including Dwight Harken and Charles Bailey) had explored the interior of the heart through atrial appendage pursestrings for closed mitral valve surgery and for foreign body extraction. Rumel's tourniquet afforded an easy method to achieve controlled and continuous tension on a pursestring suture to limit blood loss around a finger or tube entering a blood filled structure. ![[Rumel Tourniquet 1.png]] Although it comes in various forms, the device works like any other tourniquet through the compression of vasculature to control blood loss. The functional device most commonly consists of a metal obturator with a blunt hook tip passed through a rubber tube. The hook is used to snare the ends of a tying medium such as umbilical tape passed around a vessel or a purse-string suture around an incision. The ends of the tying medium are subsequently pulled back through the rubber tube using the obturator hook. Tension is applied to the tying medium within the rubber tube, cinching the desired vessel or pursetring, and is maintained by compression along the length of the tubing. A clamp is applied to the tying medium through the walls of the tubing, causing constant compression of the desired target. The most commonly used tubing is a red rubber robinson catheter, though other materials can be used where other concerns such as latex allergy dictate. In mechanical circulatory support situations where the Rumel tourniquet must be left temporarily within the patient, the role of the hemostat can be replaced by passing the sutures through sterile buttons and tying them down over the button. Sources: https://www.whonamedit.com/doctor.cfm/3542.html https://medicine.utah.edu/surgery/vascular-surgery/news/2020/08/division-of-cardiothoracic- surgery-holds-first-annual-william https://www.ksl.com/article/35620573/utah-inventions-a-surgeon-who-used-kitchen-utensils-to-save-lives Welling DR, Rich NM, Burris DG, Boffard KD, Devries WC. Who was William Ray Rumel? World J Surg. 2008 Sep;32(9):2122-5. doi: 10.1007/s00268-008-9599-4. PMID: 18443854. https://medical-dictionary.thefreedictionary.com/Rumel+tourniquet https://www.biologyonline.com/dictionary/rummel-tourniquet https://surtex-instruments.com/product/rumel-belmont-tourniquet/ https://novosurgical.com/rumel-tourniquet-obturator.html