Page 16 - JSOM Fall 2025

FIGURE 2 Example pressure traces.
Example traces of tourniquet pressures from tourniquet application through tourniquet release and removal. Pressures were collected every
second and shown as small open circles with connecting lines. Named pressure and time events are marked by ×’s pointed at by arrows from
text indicating the names of the events. Windlass-rod tourniquets often have time between reaching a securable rod position and completing all
tourniquet rod- and strap-securing steps. (A) Example arm PULS application (magenta) with no return of pulse before release. (B) Example thigh
SICH (blue) and X8T (black) applications with no return of pulse before release.

(A) 1200 (B) 1200
1100 1st Tightening-System-Securable 1100 1st Tightening-System-Securable
1000
Pressures (mmHg) 900 1st Completion Pre-Release Application Pressures (mmHg) 900 1st Completion
1000
800
800
SICH 2.5 total 180° tightening-system turns
X8T 1.1 total 180° tightening-system turns
700
700
600
600
PULS 1.5 total 180° tightening-system turns
Arm Application 500 1st Occlusion Return of Arterial Flow 500 Pre-Release
400
400
300
300
1st Occlusion
Return of
200
Arterial Flow
100
100 Pre-Tightening-System-Use Thigh 200 Pre-Tightening-System-Use
0 0
0 20 40 60 80 100 120 140 160 180 200 0 20 40 60 80 100 120 140 160 180 200
Time (seconds) Time (seconds)
versus after-first- completion pressure/turn comparisons. Pear- all reached completion, and five arm and 28 thigh applications
son’s correlation was used for circumference versus occlusion had early pulse return requiring additional tightening (Table 3).
pressure and circumference and pre-tightening-system use ver-
sus tightening-system use. Chi-square test was used for contin- Pressures and Tightening-System Use
gency tables. Application pressures and tightening-system turns for each
Ukrainian-manufactured tourniquet are shown in Figure 3 with
dashed black lines indicating interquartile ranges (IQRs) for
Results
X8T applications. X8T arm application pressures are only for
Appliers circumferences >31.2cm; therefore, X8T arm occlusion pres-
There were eight appliers (one male, seven females). One fe- sure IQRs higher than those of the Ukrainian- manufactured
male applier only did one recipient’s DNIPRO and PULS tourniquets was expected. Thigh occlusion pressures with
applications. One female applier did not do any SICH appli- the full-width tightening X8T were lower than those of each
cations. The rest of the appliers had at least one application of Ukrainian- manufactured tourniquet, including the full-width
each tourniquet. tightening Y&B. As anticipated because of the X8T’s finer
resolution tightening system increments, the ranges for the
Recipients Ukrainian-manufactured tourniquet arm and thigh completion
Table 1 has recipient information. Twenty recipients did not pressures were wider, and most were higher than the X8T’s.
receive all four Ukrainian-manufactured tourniquets: seven No thigh applications crossed the greater-than-1500mmHg- at-
only had SICH, four only had DNIPRO and PULS, five only completion-pressure threshold for early release. No X8T arm
had Y&B, and the rest had applications of three of the four applications crossed the greater-than-800mmHg-at- completion-
Ukrainian-manufactured tourniquets. pressure threshold for early release. At first completion, five
Ukrainian-manufactured tourniquets crossed the early-release
Tourniquet-Secured Arterial Occlusion arm pressure threshold (1 SICH-rod into completion position
(Successful Completion) but hands never left the tourniquet, so not hands-off completion
Table 2 has information about achieving hands-off, tourniquet- before release; 1 DNIPRO; and 3 PULS). Of arm applications
secured arterial occlusion. As expected, pressures decreased requiring additional tightening (5 SICH, 5 DNIPRO, 8 PULS,
16
after each completion (completion defined as hands off after 8 Y&B, and 3 X8T), eight crossed the early-release pressure
securing the tightening system and completing any additional threshold (1 SICH, 1 DNIPRO, and 6 PULS).
tourniquet-securing steps, Figure 2). One Y&B thigh applica-
tion never reached completion for physical inability to achieve Occlusion pressures of applications that required additional
the needed sixth windlass-rod rotation and secure the rod. tightening after the first completion were intermixed with
One SICH arm application was never completed because the occlusion pressures of applications that did not require addi-
application would have been completed above the 800mmHg tional tightening (Figure 3A, 3B). First completion pressures
arm pressure threshold (was released from the completion po- of applications that required additional tightening were more
sition without hands off the tourniquet). Among the 238 other frequently (but not entirely) in the lower half of all first com-
Ukrainian-manufactured tourniquet applications, 26 arm and pletion pressures. Pre-release pressures of applications that re-
43 thigh applications had early pulse return requiring addi- ceived additional tightening were predominantly in the upper
tional tightening (Table 3). Among the 80 X8T applications, half of all pre-release pressures.

14 | JSOM Volume 25, Edition 3 / Fall 2025