Page 39 - JSOM Spring 2026

additional click twice, and one required an additional click Discussion
three times (Figure 3).
The study purpose was evaluation of X8T pressures and tight-
No pressures were over 500mmHg. Occlusion and first com- ening-system use during arm and thigh applications. The key
pletion pressures of X8T applications that required additional findings were that every X8T application reached arterial oc-
tightening after the first completion were intermixed with clusion and maintained occlusion with limited, simple, quick
those that did not require additional tightening (Figure 3). Pre- tightening-system advances. To maintain occlusion for 100
release pressures were also intermixed. seconds, only 5 of 40 arm applications needed an advance-
ment click beyond that used for first completion. For thigh
Of the 17 arm applications with pressure monitoring and applications, maintaining occlusion required at least one addi-
clicks to reach occlusion, two had an additional click after first tional advancement click in 28 of 40 applications.
completion, both of which had greater pressure increases than
the click from occlusion to first completion (Figure 4). One The advancement click data indicates that two clicks past ini-
of the two arm applications with pressure monitoring that tial arterial occlusion might be a better first completion choice
occluded pre-tightening system use had two additional clicks than only one click, especially for thigh applications, and, as
before release, and the second additional click had a greater with all tourniquets, ongoing reassessments are critical. In a
pressure increase than the first. non-laboratory but also non-chaotic setting, we suggest that
a clinical user might target two clicks past visible cessation of
Thigh applications generally had lower first-occlusion to first- bleeding before checking any available distal pulse location. In
completion pressure increases than arm applications (Figure a chaotic setting such as care under fire or a setting with poor
4). Of the 28 thigh applications with at least one additional visibility, we recognize that an applier may be rapidly rotating
click, 26 had greater pressure increases than the click from the dial to what they perceive as “very tight” and carefully
occlusion to first completion (Figure 4). The three occurences assessing for ongoing bleeding or a distal pulse at a much later
of second additional clicks had greater pressure increases than time point. Fortunately increasing the tightness of the X8T
their first additional clicks. The sole third additional click had is fast and easy, does not risk losing hold of a windlass rod
a 2.5mmHg smaller pressure increase than its second addi- and thereby inadvertently releasing the tourniquet, and can be
tional click. done with much finer pressure increments than allowed with
windlass-rod tightening systems (one-tenth of a 180° dial ro-
As expected, larger circumference limbs required higher tation versus a full 180° windlass-rod rotation).
6-8
pressures for occlusion (P<.0001). Larger circumference limbs
and lower achieved pre-tightening-system-use pressures were The tightening system of the 3.8cm-wide X8T creates full-
both associated with needing more total clicks of the tight- width shortening of the limb-encircling strap (a contrast to the
ening system (circumference arm P=.168, thigh P<.0001, 2.54cm-width shortening of tourniquets such as the Combat
®
pre-tightening-system use arm P<.0001, thigh P=.0003). A Application Tourniquet [CAT, CAT Resources, Rock Hill, SC,
clear example of lower pre-tightening-system-use pressure USA; https://combattourniquet.com]). The X8T thigh occlusion
(92mmHg) combined with large circumference thigh (75.5cm) pressures recorded in this study (range 273–478mmHg, median
needing higher pressure (478mmHg) and more clicks (39) for 359mmHg, IQR 334–389mmHg) are similar to those reported
occlusion is shown in panel D of Figure 4 (39 clicks = 3.9 180° with other adult recipients and the same pressure measuring sys-
dial rotations from the starting location). tem with two other 3.8cm-wide, full-width-tightening- system
tourniquets: the Tactical Ratcheting Medical Tourniquet (Tac
®
Applications with pressure data also had time data. The four RMT, m2 inc., Colchester, VT, USA; https://m2inc.biz, median
arm-application additional clicks took 2 seconds each from 338mmHg, IQR 356–415mmHg) and the Special Operations
pulse detection to hands-off after completion of one click of Forces Tactical Tourniquet Generation 3 (SOFTTW3, TacMed
™
dial rotation. The 32 thigh-application additional clicks took Solutions , Anderson, SC, USA; https://tacmedsolutions.com,
9
a median of 2 seconds (minimum 1, IQR 2, 3, maximum 4 median 348mmHg, IQR 317–384mmHg).
seconds) from pulse detection to hands-off after completion of
one click of dial rotation. All but two of the X8T recipients were also recipients in a
concurrent study of four Ukrainian-manufactured wind-
General Design Considerations lass-rod-tightening-system tourniquets, and the X8T thigh
Creating separation between the tightening-system dial and occlusion pressures were lower than recorded with the three non-
base teeth to release the tourniquet was sometimes challeng- full-width, Ukrainian-manufactured windlass-rod-tightening-
ing. The difficulty related to the magnitude of separating force system tourniquets: the Strengthened Individual Combat Hy-
needed combined with lack of area for pushing down on the brid Tourniquet (median 423mmHg, IQR 388–471mmHg;
base with thumbs while pulling up on the handles of the dial SICH, SICH Ukraine, LLC, Kyiv, Ukraine; https://sicheurope.
with fingers. com), TQ DNIPRO Gen 2 (median 426mmHg, IQR 371–
469mmHg; DNIPRO, TQ DNIPRO, Dnipro, Ukraine; https://
We did not find any visible evidence of wear on either the left- tqdnipro.com), and PULS Tourniquet (median 398mmHg,
or right-applied X8T. IQR 354–450mmHg; PULS, PULS Tourniquet, Ternopil,
10
Ukraine; https://www.facebook.com/puls.tourniquet/?_rdr).
9
The self-securing nature of the X8T tightening system pre- This is quite similar to the difference noted in the prior study
cluded incidences of tightening system physical struggles we when comparing the same type of non-full-width, windlass-
have observed with windlass-rod tightening systems, namely, rod-tightening-system CAT (median 424mmHg, IQR 375–
losing hold of the windlass rod during tightening and difficulty 485mmHg) to the full-width-tightening-systems Tac RMT and
securing the windlass rod in a bracket, clip, or triangle. 1,2,9,10 SOFTTW3.

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