Page 13 - JSOM Fall 2025

Lab Evaluation of

Four Ukrainian-Manufactured Tourniquets

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

ABSTRACT
Background: We evaluated arterial occlusiveness, 180° turns, Introduction
pressures, reuse wear, and design aspects of four Ukrainian-
manufactured tourniquets. Methods: Strengthened Individual Effective emergency-use limb tourniquets are first-aid items of
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Combat Hybrid Tourniquets (SICH), TQ DNIPRO GEN 2s life-saving importance in military conflicts. To be effective,
(DNIPRO), PULS tourniquets (PULS), and Yellow&Blue tour- emergency-use limb tourniquets must allow achievement and
niquets (Y&B) were each applied to left/right, mid-arm and hands-free maintenance of arterial occlusion when correctly
mid-thigh, of 30 recipients, 100 seconds first-completion-to- applied. This requires designs that allow appliers to achieve
release. Results were compared to concurrent study X8T-T2G tourniquet security with adequate circumferential pressure
(n=40). Results: All applications reached occlusion. Some thigh for arterial occlusion. Additionally, the designs should involve
Y&B could not be secured: 1 never; three after additional turn. materials and construction techniques with sufficient robust-
Twenty-six arms, 43 thighs needed an additional turn (median ness to withstand the forces to which they will be subjected
total turns arm 1.5 SICH, DNIPRO, PULS; 2.5 Y&B and during the initial application through all subsequent adjust-
thigh 2.5 SICH, DNIPRO; 2.0 PULS; 3.5 Y&B; p<.0001 oth- ments occuring from point-of-injury to definitive care.
ers versus Y&B; X8T-T2G arm 0.7, thigh 1.5, p≤.0004 versus
Ukrainian-manufactured). Ukrainian tourniquets pre-release, We were contacted on 25 August 2023 by COL (Ret.) John F.
39 arm and 83 thigh were >500mmHg (median range: occlu- Kragh, Jr. MD, regarding possible help evaluating emergency-
sion arm 255–274mmHg, thigh 398–423mmHg; first comple- use limb tourniquets of Ukrainian manufacture. We offered
tion arm 349–588mmHg, thigh 474–572mmHg; pre-release what we could do to help: assess tourniquet mid-arm and
arm 350–638mmHg, thigh 517–583mmHg). No X8T-T2G mid-thigh arterial occlusiveness according to distal audible
>500mmHg (median pre-release arm 304mmHg, p<.002 versus Doppler signal; include tourniquet pressure information re-
SICH, DNIPRO, PULS and p=.522 versus Y&B; thigh 367mmHg, garding how tightly appliers pull and secure the strap, pres-
p<.0001 versus Ukrainian-manufactured). For per-turn pressure sure at occlusion, and pressure at completion with hands off;
increases arm>thigh (p<.0001) and additional turns>turns-to- look for visually apparent damage with multiple uses; and
first-completion (p<.0001). Y&B concerns: stitching failures at identify difficulties encountered during use in the laboratory.
rod-loop and limb-encircling strap connection; clip bending; Email conversations followed with the inclusion of Col (Ret.)
potential slider-redirect-buckle-pieces loss, incorrect slider- Warren Dorlac, MD.
redirect-buckle rethreading, and windlass-rod removal; and
rod-securing inability. On 44.2–75.0cm- circumference thighs, The study purpose was a laboratory evaluation of the fol-
hook-and-loop-strap-base-area-strap-securing mechanisms were lowing aspects of four Ukrainian-manufactured tourniquets:
not reached on 39% of applications. Conclusions: The SICH, 1) achievement and maintenance of tourniquet-secured, arm
DNIPRO, and PULS always reached completable arterial oc- and thigh arterial occlusion, 2) pressures involved in use, 3)
clusion; Y&B did not and had design concerns. None became amount of visible wear with reuses, and 4) general design con-
nonfunctional. Windlass-rod-tightening-system tourniquets siderations. The hypotheses were as follows: 1) all tourniquets
routinely have higher-than-desirable completion pressures, would be able to achieve and maintain tourniquet-secured,
which matters with long tourniquet times. Current hook-and- arm and thigh arterial occlusion on all subjects, 2) occlusion
loop-limb-encircling straps are too short to engage base- area- pressures would be similar to reports for similar 3.8cm-wide
strap-securing mechanisms on many adult thighs. nonelastic tourniquets with the same pressure-measuring sys-
tem (higher for designs with other than full-width strap tight-
ening), and 3) minimal visible wear would occur. Because we
Keywords: tourniquet; hemorrhage; first aid; emergency;
occlusion; pressure had an already planned, concurrent study with the X8T-T2G
tourniquet (X8T, RCR Medical, McKinney, TX), we also
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*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
now in dental school at the University of Iowa, Iowa City, IA.
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