Comparison of Three Junctional Tourniquets Using a Randomized Trial Design

Area of Science:

• Trauma care
• Emergency medicine
• Surgical devices

Background:

• Hemorrhage from junctional wounds is a leading cause of preventable death.
• Traditional tourniquets are ineffective for junctional injuries.
• Junctional tourniquets (JTQs) aim to control bleeding by compressing arteries in the trunk-extremity junction.

Purpose of the Study:

• To compare the application time, effectiveness, and user preference of three FDA-cleared JTQs: CRoC®, JETT™, and SJT.
• To evaluate the performance of JTQs in achieving pulse elimination and maintaining it during transport.
• To identify user preferences and areas for product improvement.

Main Methods:

• Forty-nine active duty corpsmen received standardized training on CRoC®, JETT™, and SJT.
• Each participant applied the JTQs unilaterally in a randomized order to a peer.
• Pulse elimination was assessed via Doppler ultrasound, with reevaluation after a short transport period; user preference data were collected.

Main Results:

• The CRoC® had a significantly longer application time compared to JETT™ and SJT.
• All tested JTQs demonstrated similar effectiveness in pulse elimination.
• The SJT showed significantly higher effectiveness during transport than the JETT™, though overall transport effectiveness for all devices was low (24-48%).
• The SJT was preferred for ease of use, stability, reliability, user trust, and overall preference.

Conclusions:

• Current JTQ devices exhibit limitations in maintaining hemorrhage control during patient transport.
• Despite performance gaps during transport, JTQs hold potential for reducing mortality from junctional wounds.
• Product improvements are necessary to enhance JTQ effectiveness during patient movement and transport.