Page 36 - JSOM Spring 2026

Lab Evaluation of X8T-T2G Tourniquet

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Piper Wall, DVM, PhD *; Charisse Buising, PhD ; Mary Jonas, BS 3

ABSTRACT
Background: We evaluated pressures and tightening-system toward definitive care. Compared to windlass-rod-based tight-
use of 3.8cm-wide, self-securing-strap/redirect-and-tightening- ening systems, most self-securing tightening systems also have
system X8T-T2G tourniquets (X8Ts). Methods: Applied left/ pressure-increment-resolution advantages, advantages in the
right, mid-arm and mid-thigh, 40 recipients, first completion speed and ease of increasing pressure when needed after the
one-click-past arterial occlusion, release 100s later. Compared first completion of tourniquet application, and potential situa-
to concurrent study: four 3.8cm-wide, windlass-rod-tighten- tional awareness advantages.
ing-system tourniquets (n=30 each). Results: All X8T reached
occlusion and completion without securing struggles. Main- We previously determined the X8T-Tourniquet (RCR Medical,
taining occlusion till release, 3 arms/25 thighs required ad- McKinney, TX, USA; www.rcrmedic.com) could be arterially
ditional click once, 2/2 required twice, and 1 thigh required occlusively and securely applied by inexperienced and experi-
thrice. Nineteen arms large enough for X8T pressure moni- enced appliers with a median application time of 37.39 sec-
toring: occlusion median 298mmHg (minimum 188, inter- onds from being told to pick up the tourniquet to completing
quartile range 262, 322, maximum 335), first completion the application. 1,2
338mmHg (219, 310, 372, 391), pre-release 304mmHg (172,
270, 323, 342). Thigh pressures: occlusion 359mmHg (273, The study purpose was evaluation of X8T-T2G tourniquet
334, 388, 478), first completion 393mmHg (308, 366, 426, (X8T) pressures and tightening-system use during arm and
489), pre-release 368mmHg (289, 339, 390, 462); each< thigh applications. The hypotheses were as follows: 1) arte-
respective windlass-rod tourniquet pressures (every P<.030). rial occlusion and occlusion maintenance would be achievable
Arm clicks: occlusion 5 (0, 4, 7, 10), first completion 6 (1, 5, 8, with pressures similar to other full-width-tightening-system,
11), pre-release 7 (1, 5, 8, 11); first completion and pre-release 3.8cm-wide nonelastic tourniquets, 2) completion pressures
tightening-system rotation<windlass-rod tourniquets (every would be lower than with windlass-rod tightening systems,
P<.0001, 10 clicks=180°). Thigh clicks: occlusion 13 (6, 10, 3) total tightening-system use would be less than with wind-
16, 39), first completion 14 (7, 11, 17, 40), pre-release 15 (7, lass-rod tightening systems, and 4) any tightening-system use
12, 18, 41); first completion and pre-release tightening-system after first completion would be faster than with windlass-rod
rotation<windlass-rod tourniquets (one pre-release P=.072, all tightening systems.
other P<.005). Clicks after first completion took 2s (1, 2, 3,
4); faster than 66 additional uses of windlass-rod tightening Methods
systems (medians 10-18s, every P<.0001). Conclusions: X8Ts
were arterially occlusive with simple, self-securing, tighten- The Drake University Institutional Review Board approved
ing-system advances. Versus windlass-rod systems, first com- this prospective study (#2023-24010), which took place Au-
pletion and pre-release pressures and total tightening-system gust 2023 through April 2024. All recipients were volunteers
rotation were lower, and completion of tightening-system use who had the study explained to them, inclusive of data to be
after first completion was faster. collected, and read and signed an informed consent. All recipi-
ents were told and read that they could withdraw at any time.
Keywords: tourniquet; occlusion; pressure; hemorrhage; first
aid; emergency Tourniquets
The X8Ts (manufactured 04/25/2022) were requested from
and donated by the manufacturer. We had four X8Ts: one for
visual comparisons (never applied), one for practicing, one for
Introduction
right limbs, one for left limbs.
Emergency-use limb tourniquets with clips, self-securing strap/
redirect systems, and self-securing tightening systems have The X8T (Figure 1) is a 3.8cm-wide, 156cm-long, 120.14g non-
speed and security advantages. Time to tourniquet-related elastic emergency-use limb tourniquet that involves full-strap-
1,2
arterial occlusion affects how much blood is lost, and time width tightening. The X8T has a self-securing double redirect
to tourniquet-application completion affects time not doing strap/redirect system that cannot be unthreaded and has a clip
something else such as addressing other injuries or moving for securing around a trapped limb. The X8T has a self-securing
*Correspondence to piperwalldvm@gmail.com
1 Dr. Piper Wall is a researcher in the Department of Research, UnityPoint Health Iowa Methodist Medical Center, Des Moines, IA. Dr. Charisse
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Buising is a professor of biology at Drake University, Des Moines, IA. Mary Jonas was an undergraduate researcher at Drake University and is
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now in dental school at the University of Iowa, Iowa City, IA.
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