Lab Evaluation of Four Ukrainian-Manufactured Tourniquets.

Background: We evaluated arterial occlusiveness, 180° turns, pressures, reuse wear, and design aspects of four Ukrainian-manufactured tourniquets.

Methods: Strengthened Individual Combat Hybrid Tourniquets (SICH), TQ DNIPRO GEN 2s (DNIPRO), PULS tourniquets (PULS), and Yellow&Blue tourniquets (Y&B) were each applied to left/right, mid-arm and mid-thigh, of 30 recipients, 100 seconds first-completion-to-release. Results were compared to concurrent study X8T-T2G (n=40).

Results: All applications reached occlusion. Some thigh Y&B could not be secured: 1 never; three after additional turn. Twenty-six arms, 43 thighs needed an additional turn (median total turns arm 1.5 SICH, DNIPRO, PULS; 2.5 Y&B and thigh 2.5 SICH, DNIPRO; 2.0 PULS; 3.5 Y&B; p<.0001 others versus Y&B; X8T-T2G arm 0.7, thigh 1.5, p≤.0004 versus Ukrainian-manufactured). Ukrainian tourniquets pre-release, 39 arm and 83 thigh were >500mmHg (median range: occlusion arm 255-274mmHg, thigh 398-423mmHg; first completion arm 349-588mmHg, thigh 474-572mmHg; pre-release arm 350-638mmHg, thigh 517-583mmHg). No X8T-T2G >500mmHg (median pre-release arm 304mmHg, p<.002 versus SICH, DNIPRO, PULS and p=.522 versus Y&B; thigh 367mmHg, p<.0001 versus Ukrainian-manufactured). For per-turn pressure increases arm>thigh (p<.0001) and additional turns>turns-to-first-completion (p<.0001). Y&B concerns: stitching failures at rod-loop and limb-encircling strap connection; clip bending; potential slider-redirect-buckle-pieces loss, incorrect slider-redirect-buckle rethreading, and windlass-rod removal; and rod-securing inability. On 44.2-75.0cm-circumference thighs, hook-and-loop-strap-base-area-strap-securing mechanisms were not reached on 39% of applications.

Conclusions: The SICH, DNIPRO, and PULS always reached completable arterial occlusion; Y&B did not and had design concerns. None became nonfunctional. Windlass-rod-tightening-system tourniquets routinely have higher-than-desirable completion pressures, which matters with long tourniquet times. Current hook-and-loop-limb-encircling straps are too short to engage base-area-strap-securing mechanisms on many adult thighs.