Page 119 - JSOM Summer 2020

randomized controlled trials would be of most benefit in clar- FIGURE 1 The SOFT-T is a windlass-type tourniquet with a safety
ifying tourniquet efficacy, this work aims to summarize the screw and triangular loops to lock the windlass (obtained with
most recent and relevant research conducted into these other permission from https://www.tacmedsolutions.com/).
models of tourniquet as possible alternatives to the CAT.

Methods
A PubMed search from January 2012 to January 2020 was
made for articles comparing the CAT6 and CAT7 with com-
mercially available alternative models. While the CAT6 and
CAT7 are different, the former has only been shown to be
inferior in regard to structural integrity and user preference
with largely similar occlusion efficacy, and thus both models
were considered to be equivalent in this analysis. 11,12 They are
referred to as “CAT” for the remainder of this review. A list of
available extremity tourniquets was made by both consulting
the CoTCCC recommendations and performing a search in
Google with the phrase “tourniquet” and seeing what models
of tourniquet were found. These models of tourniquet were A wider version of it with a 1.5-inch strap, the SOFTT-W, is
then searched for in PubMed within the above time range also available, featuring a longer windlass, a retention hook
to see if they have been compared with the CAT tourniquet. to hold the windlass while the user engages the now singular
14
Tourniquets that were both commercially available and found triangular ring, and no safety screw (Figure 2). Montgomery
within our PubMed search were included in our review. et al. graded the SOFTT-W highly at 41.39 but the SOFT-T at
34.17 due to decreased occlusion and not meeting the device
specification of width greater than 1.5 inches. Accordingly,
Results only the SOFTT-W is CoTCCC approved. 11
While many alternative models of tourniquet were commer-
cially available, only 12 were also found through our PubMed Given their similar appearances, it is understandable that the
review. These models can be grouped into four categories based SOFT-T is no more intuitive than the CAT. A study by Dennis
on their application method. The models that use a windlass, et al. analyzed the ability of laypeople to successfully apply
similar to the CAT, are the Special Operations Forces Tactical the SOFT-T, CAT, and SAM-XT windlass tourniquets in a sce-
Tourniquet (SOFT-T), the SOFT-T Wide version (SOFTT-W), nario with life-threatening hemorrhage onto HapMed tourni-
the SAM-XT tourniquet, the Tactical Medical Tourniquet quet trainers using only the manufacturer’s instructions. The
(TMT), and the Military Emergency Tourniquet (MET). 13–17 SAM-XT tourniquet, approved by the CoTCCC for a score
Three that are primarily elastic and function by wrapping of 40.80 by Montgomery et al., is incredibly similar to the
multiple times around the patient’s appendage are the Stretch, CAT but features as its first step inserting the free belt loop
Wrap, And Tuck Tourniquet (SWAT-T), the Israeli Silicone end through a clip at the other end that locks down on the
Tourniquet (IST), and the Rapid Activation Tourniquet System strap (Figure 3). 11,15 Regardless of CoTCCC approval, how-
(RATS). 18–20 Others tighten by a ratcheting mechanism, specif- ever, all three models had low success rates, ranging from
28
ically the Ratcheting Medical Tourniquet (RMT) and the TX2 61% to 72%, that were insignificant from one another. Such
and TX3 tourniquets. 21,22 Finally, the Emergency and Military similar performances between the CAT and SOFT-T were also
Tourniquet (EMT) and Tactical Pneumatic Tourniquet (TPT) demonstrated by Heldenberg et al., who assessed the ability of
work by pneumatically inflating a circumferentially-applied Israeli combat team members, both medic and nonmedic, in
bladder to apply pressure, similar to a blood pressure cuff. 23,24 placing the CAT and SOFT-T on other teammates, confirming
vessel occlusion by Doppler ultrasound. While both models
Other available tourniquets, such as the OMNA Amphibious
Tourniquet, designed for use by surfers in the event of surf- FIGURE 2 The SOFTT-W is similar to the SOFT-T, but has a
wider strap and no safety screw (obtained with permission from
ing trauma, and the STAT tourniquet, designed to emulate a https://www.tacmedsolutions.com/).
zip-tie, were not included as no current literature has assessed
their efficacy. 25,26 Older tourniquets, like the Mechanical Ad-
vantage Tourniquet (MAT), only have literature assessing its
performance outside of the selected time range and therefore
were not included in this review. 5,27

Discussion
Windlass-type Tourniquets
There are many other windlass-type tourniquets available on
the market other than the CAT tourniquet. The SOFT-T is ap-
plied in a manner similar to that of the CAT but features a
safety screw on the clamp, which should be loosened prior to
tightening by pulling the 1-inch-wide looped strap (Figure 1).
Only after the windlass has been tightened and secured in one
of the triangular rings should the safety screw be secured. 8,13

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