Page 38 - JSOM Spring 2026

FIGURE 2 Example pressure traces. analyses were performed with GraphPad Prism, version 7.04
for Windows (GraphPad Software Inc., Boston, MA, USA;
www.graphpad.com). Unpaired t tests were used for pressure,
tightening-system use, and pressure/click comparisons. Paired
t tests were used for per-click pressure comparisons for first-
completion versus after-first-completion. Pearson’s correlation
was used for circumference versus occlusion pressure and cir-
cumference and pre-tightening-system use versus tightening-
system use. Fisher’s exact test was used for contingency tables.

Results
Appliers
There were 7 appliers (1 male, 6 females, 6 undergraduates,
1 team leader). All of the undergraduate appliers were 19 to
22 years old. Three of the 6 undergraduate approved appliers
were in their first year with the research team (appliers on
14, 9, and 6 recipients). Two were in their second year with
the team (appliers on 4 and 2 recipients); the tourniquet with
which they gained experience in the prior year was the Tac-
Example traces of tourniquet pressures from application through re- tical Pneumatic Tourniquet 2inch (Alphapointe Tactical &
™
lease and removal. Pressures were collected every second and shown
as small open circles with connecting lines. Named pressure and time Medical, Kansas City, MO, USA; Alphapointe.com). One stu-
events are each marked by an × pointed at by an arrow from a text la- dent was in her third year (applier on 4 recipients); so she had
bel indicating the name of the event. The arm application trace is green. experience with the Tactical Pneumatic Tourniquet 2inch and
The thigh application trace is blue. The limb circumferences are shown the OMNA Marine tourniquet (OMNA Inc. St. Petersburg,
with each trace. The arm application did not have a return of arterial
flow before release and therefore also did not have a 2nd completion. FL, USA; www.marinetourniquets.com). The team leader who
applied on 1 recipient was 59 years old.
X8T happened after each advancement click. First completion
was one click past first arterial occlusion. Returns of arterial Recipients
flow before 100 seconds from first completion resulted in an Table 1 has recipient information.
additional tightening click. Pre-release pressure was taken 100
seconds from first completion. Pressures and Tightening-System Use
All 80 X8T applications reached completion. Five arm and 28
PW supervised applications and called Doppler signal loss and thigh applications had pulse return before 100 seconds requir-
return. A separate person ran the pressure collection software ing additional tightening (Figure 3).
and also listened for Doppler signal loss and return. Recipients
had the option to stop at any time. Six arm applications occluded without tightening-system use.
Four of those did not require tightening-system use beyond the
Resetting and Cleaning click to completion. After first completion, three arm applica-
The dial and strap/redirect systems were reset after each use. tions required an additional click once and two required an
Each X8T was sprayed with 70% denatured ethyl alcohol and additional click twice (Figure 3). X8T arm application pres-
allowed to dry between recipients. sures are only for arms >31.2cm circumference, but clicks were
counted for every application.
Statistical Analysis
Data were organized in Excel for Microsoft 365 MSO ( Version No thigh applications occluded without tightening-system
®
2508 Build 16.0.19127.20082 64-bit; Microsoft Corp., Red- use (P=.026 versus arm). After first completion, 25 thigh ap-
mond, WA, USA; www.microsoft.com). Graphing and statistical plications required an additional click once, two required an

TABLE 1 Tourniquet Recipient Information
Group; median (minimum, 25th percentile, 75th percentile, maximum)
All Arm circumference <31.3cm Arm circumference ≥31.3cm
Number of recipients 40 21 19
Sex, F; M 27 F, 13 M 19 F, 2 M 8 F, 11 M
Age, y 20 (19, 20, 22, 68) 20 (19, 20, 20.5, 64) 21 (19, 20, 58, 68)
Height, cm 170 (152, 163, 180, 193) 165 (152, 161, 172, 191) 180 (155, 168, 183, 193)
Weight, kg 71.4 (47.2, 62.8, 95.2, 133.8) 63.5 (47.2, 56.3, 69.2, 81.7) 95.3 (68.0, 77.1, 102.1, 133.8)
Systolic blood pressure, mmHg 124 (91, 113, 131, 165) 114 (91, 110, 126, 130) 131 (112, 122, 139, 165)
Arm circumference, cm 31.3 (23.1, 26.7, 35.4, 40.5) 26.8 (23.1, 25.3, 29.6, 31.5) 35.4 (32.0, 32.9, 37.0, 40.5)
[n=19 arm X8T pressures group
35.4 (32.0, 32.9, 37.0, 40.5)]
Thigh circumference, cm 56.1 (43.7, 52.5, 61.5, 75.5) 52.8 (43.7, 49.8, 55.8, 62.1) 61.2 (54.3, 56.1, 63.8, 75.5)
X8T = X8T-T2G tourniquet.

36 | JSOM Volume 26, Edition 1 / Spring 2026