Page 92 - JSOM Winter 2023

Pressure Data There are reports of counterfeit tourniquets. 18,19 While tourni-
Each trial was recorded individually. Then data from 15 trials quets may seem simple to produce, counterfeit versions have a
on each tourniquet was averaged and plotted for comparison history of catastrophic failures leading to poor patient outcomes.
(Figure 4). With counterfeit tourniquets, anecdotal reports have suggested
that the tension rod used to stop blood flow has broken before
the user can obtain adequate hemostasis. This is potentially en-
Discussion
dangering the patient. It is therefore vital that 3D-printed tour-
We aimed to compare three types of tourniquets—two com- niquets, such as the one tested in this study, have outstanding
mercially available versions and one 3D-printed version—as quality and can be trusted in life-threatening situations.
used in low-resource environments for their ability to generate
and maintain a pressure capable of providing limb arterial oc- Limitations
clusion. These results indicated that a 3D-printed tourniquet Several factors can limit the generalizability of the results in
can be a valuable tool and a reasonable alternative to the ex- this study. First and foremost, we cannot assure that every
isting and recommended commercial models. 3D-printed tourniquet is identical. The whole concept of using
different 3D printers in various locations and with various ma-
The 3D-printed Ukrainian model holds pressure as well as the terials is not flawless with respect to standardization and com-
standard tourniquets. Indeed, our test results suggested that it parability. However, since the 3D-printed tourniquet is already
actually holds the pressure better than the two standard mod- in widespread use, we found it necessary to test a sample appro-
els tested in this study. While our study does not reveal the true priately. Second, we only tested one of each type of tourniquet in
difference, we could speculate that the Ukrainian model uses this study, and there is a risk of bias when the researchers apply
different webbing than the SOF and CAT tourniquets with the tourniquet rather than a third-party participant.
better compliance.
The lack of a standardized and validated method of tourniquet
The results do not fit the current advice that only the approved testing constrained the methodological choices. It is beyond
tourniquets should be used. Still, we consider certifications the scope of this study to do validation, but we would recom-
and approval concepts necessary, especially for medical and mend that such be done in the future.
life-saving equipment and do not challenge the need for such
certifications. However, there is much value if this type of gear Avenues for further research include testing the tourniquets in
can be produced close to the battlefield. Factors including lo- various conditions, such as in hot, cold, and wet environments
gistics, availability, and self-sufficiency are important during (or other U.S. Military Standards like MIL-STD-810). We also
wartime. propose medical feasibility testing in combat-like conditions,
such as applying them over clothing, self-applying, and apply-
There are also essential factors of cost and pricing. For ex- ing in darkness.
ample, the 3D-printed version costs less than one-tenth of
a typical conventional tourniquet. For countries in war, this Finally, we would like to highlight the following points. When
is an unneglectable factor that undoubtedly needs to be producing 3D-printed tourniquets, it is crucial to use high-
considered. quality materials and thorough assembly methods to prevent

FIGURE 4 Pressure loss in mmHg for three different types of tourniquets.

(

90 | JSOM Volume 23, Edition 4 / Winter 2023