Page 19 - JSOM Fall 2025

FIGURE 3 Tourniquet pressures and tightening-system use.
For each Ukrainian-manufactured tourniquet, each application is shown with a circle; the whiskers extend from minimum to maximum; the
boxes extend from the 25th percentile to 75th percentile (bounding the IQR for each Ukrainian-manufactured tourniquet); and the medians are
inside the boxes and sometimes obscured by the circles. Data for SICH applications are blue, for DNIPRO are green, for PULS are purple, and
for Y&B are brown. Data for Ukrainian-manufactured tourniquet applications that required additional tightening after the first completion have
circles with red-filled centers.
IQRs for X8T applications are indicated by dashed lines at the 25th percentile and 75th percentile (n=19 for X8T arm pressures; n=40 for X8T
thigh pressures and arm and thigh tightening-system use; n=17 for X8T arm per-turn, first-completion pressure increases; n=4 for X8T arm
per-turn, additional-tightening pressure increases; n=40 for X8T thigh per-turn, 1st-completion pressure increases; n=32 for X8T thigh per-turn,
additional-tightening pressure increases). All p values ≤.2 are reported.
For almost every tourniquet, arm pre-tightening-system-use pressures were higher than thigh (SICH p=.044, DNIPRO p<.0001, PULS p<.0001,
Y&B p=.757, X8T p<.0001); thigh occlusion pressures were higher than arm (p<.0001 for each tourniquet), and thigh applications involved
more tightening-system 180° turns (p<.0001 for each tourniquet). Median arm 1st completion pressures and pre-release pressures were higher
than thigh with the PULS (1st completion p=.490, pre-release p=.060). In contrast, median arm 1st completion and pre-release pressures were
lower than thigh pressures with every other tourniquet (1st completion p<.006 SICH, DNIPRO, Y&B, and X8T; pre-release p<.040 SICH and
p<.0007 DNIPRO, Y&B, and X8T).

(A) Arm Application Pressures. P values ≤.2 for pressure comparisons between the tourniquets are as follows:
• Pre-Tightening-System-Use Pressures: mmHg medians SICH 166, DNIPRO 212, PULS 227, Y&B 108, X8T 197; one-way ANOVA: p≤.010
SICH<DNIPRO; p=.0001 SICH<PULS; p<.0001 Y&B<SICH, DNIPRO, PULS, and X8T; p=.165 SICH<X8T. Repeated measures one-way
ANOVA only Ukrainian-manufactured tourniquets: p=.017 SICH<DNIPRO; p=.0005 SICH<PULS; p≤.004 Y&B<SICH, DNIPRO, and PULS.
• Occlusion Pressures: mmHg medians SICH 255, DNIPRO 266, PULS 260, Y&B 274, X8T 298; one-way ANOVA: p=.038 SICH<X8T and
p=.166 DNIPRO<X8T. Repeated measures one-way ANOVA only Ukrainian-manufactured tourniquets: no p values<.572.
• 1st Completion Pressures: mmHg medians SICH 411, DNIPRO 455, PULS 588, Y&B 349, X8T 338; one-way ANOVA: p=.107 SICH<PULS,
p=.069 DNIPRO>Y&B, p=.070 DNIPRO>X8T, p≤.0004 PULS>Y&B and X8T. Repeated measures one-way ANOVA only Ukrainian-
manufactured tourniquets: p=.124 SICH>Y&B, p=.032 DNIPRO>Y&B, p=.002 PULS>Y&B.
• Pre-Release Pressures: mmHg medians SICH 436, DNIPRO 451, PULS 638, Y&B 350, X8T 304; one-way ANOVA: p=.078 SICH>Y&B,
p<.002 SICH<PULS and >X8T, p<.002 DNIPRO<PULS and >X8T, p<.0001 PULS>Y&B and X8T, p=.058 DNIPRO>Y&B. Repeated measures
one-way ANOVA only Ukrainian manufactured tourniquets: p=.0182 SICH<PULS, p=.0137 SICH>Y&B, p=.0002 DNIPRO<PULS, p=.0185
DNIPRO>Y&B, p<.0001 PULS>Y&B.
(B) Thigh Application Pressures. P values ≤.2 for pressure comparisons between tourniquets are as follows:
• Pre-Tightening-System-Use Pressures: mmHg medians SICH 145, DNIPRO 158, PULS 175, Y&B 109, X8T 122; one-way ANOVA: p=.196
SICH<PULS; p<.003 Y&B<SICH, DNIPRO, and PULS; p<.005 X8T<SICH, DNIPRO, and PULS. Repeated measures one-way ANOVA: p=.012
SICH>Y&B; p=.052 SICH>X8T; p=.190 DNIPRO<PULS; p=.0002 Y&B<DNIPRO and PULS; p≤.01 X8T<DNIPRO and PULS. Repeated
measures one-way ANOVA only Ukrainian-manufactured tourniquets: p=.180 SICH<PULS; p=.135 DNIPRO<PULS; p<.008 Y&B<SICH,
DNIPRO, and PULS.
• Occlusion Pressures: mmHg medians SICH 423, DNIPRO 426, PULS 398, Y&B 402, X8T 359; one-way ANOVA: p≤.0003 X8T<SICH and
DNIPRO, p=.019 X8T<PULS, p=.030 X8T<Y&B. Repeated measures one-way ANOVA: p=.128 SICH>Y&B; p<.002 X8T<SICH, DNIPRO,
and PULS; p=.108 X8T<Y&B. Repeated measures one-way ANOVA only Ukrainian-manufactured tourniquets: p=.089 SICH>Y&B.
• 1st Completion Pressures: mmHg medians SICH 556, DNIPRO 562, PULS 572, Y&B 474, X8T 393; one-way ANOVA: p=.190 SICH>Y&B;
p<.003 X8T<SICH, DNIPRO, PULS, and Y&B; p=.005 DNIPRO>Y&B; p=.022 PULS>Y&B. Repeated measures one-way ANOVA: p=.197
SICH>Y&B; p≤.0008 X8T<SICH, DNIPRO, PULS, and Y&B; p=.029 DNIPRO>Y&B; p=.024 PULS>Y&B. Repeated measures one-way
ANOVA only Ukrainian-manufactured tourniquets: p=.140 SICH>Y&B, p=.019 DNIPRO>Y&B, p=.016 PULS>Y&B.
• Pre-Release Pressures: mmHg medians SICH 534, DNIPRO 583, PULS 553, Y&B 517, X8T 367; one-way ANOVA: p<.0001 X8T<SICH,
DNIPRO, PULS, and Y&B; p=.149 DNIPRO>Y&B. Repeated measures one-way ANOVA: p<.0001 X8T<SICH, DNIPRO, PULS, and Y&B;
p=.073 DNIPRO>Y&B; p=.095 PULS>Y&B. Repeated measures one-way ANOVA only Ukrainian-manufactured tourniquets: p=.049
DNIPRO>Y&B, p=.065 PULS>Y&B.
(A) 1200 (B) 1200
1100 1100
1000 1000 1 add. turn unsecureable
never secured rod
Arm Application Pressures (mmHg) 700 Thigh Application Pressures (mmHg) 700 never completed,
1 add. turn not secured
900
2 add. turns not secured
900
800
800
never secured rod
600
600
500
500
400
400
300
200
200
100
100 300
Pre-Tightening Occlusion 1st Completion Pre-Release Pre-Tightening Occlusion 1st Completion Pre-Release
0 0
SICH DNIPRO PULS Y&B SICH DNIPRO PULS Y&B SICH DNIPRO PULS Y&B SICH DNIPRO PULS Y&B SICH DNIPRO PULS Y&B SICH DNIPRO PULS Y&B SICH DNIPRO PULS Y&B SICH DNIPRO PULS Y&B
(continues)

Four Ukrainian-Manufactured Tourniquets | 17