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Journal ArticleDOI

Prehospital autotransfusion in life-threatening hemothorax

01 Mar 1988-Chest (Elsevier)-Vol. 93, Iss: 3, pp 522-526

TL;DR: The preliminary results of this study suggest that autotransfusion might be developed in the prehospital setting since it appears simple and safe, and represents the only hope of survival for patients with life-threatening hemothorax.

AbstractEighteen patients with life-threatening traumatic hemothorax received prehospital autotransfusion using a simple new device. During transfer to the hospital, they received 3.9 ± 0.5 L of colloid fluid and 4.1 ± 0.6 L of autotransfused blood, without anticoagulation. Hemorrhagic blood was not coagulable, had a hematocrit of 20 ± 4 percent, few platelets, and low fibrinogen levels. Five patients died from irreversible hemorrhagic shock. Thirteen patients were alive upon admission to the hospital, underwent emergency surgery, and were discharged alive. During autotransfusion, hematocrit decreased from 24 ±3 to 19 ±3 percent, and systolic arterial pressure increased from 78 ±11 to 88 ± 12 mm Hg. Upon admission to the hospital, platelet count was 90,800 ± 21,400/cu mm, prothrombin time 48 ± 3 percent, partial thromboplastin time 197 ± 18 percent, plasma free hemoglobin levels 21 ± 7 mg/100 ml, and serum potassium levels 3.6 ± 0.5 mmol/L. No serious complication could be related to autotransfusion considered to be crucial to patients' survival. The preliminary results of this study suggest that autotransfusion might be developed in the prehospital setting since it appears simple and safe, and represents the only hope of survival for patients with life-threatening hemothorax.

Topics: Autotransfusion (61%), Hematocrit (54%)

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Citations
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Journal ArticleDOI
TL;DR: The survival and neurologic outcome of out-of-hospital cardiac arrest were not different between trauma and medical patients, suggesting that, under the supervision of senior physicians, active resuscitation after out- of- hospital cardiac arrest is as important in trauma as in medical patients.
Abstract: OBJECTIVE: It is proposed to not resuscitate trauma patients who have a cardiac arrest outside the hospital because they are assumed to have a dismal prognosis. Our aim was to compare the outcome of patients with traumatic or nontraumatic ("medical") out-of-hospital cardiac arrest. DESIGN: Cohort analysis of patients with out-of-hospital cardiac arrest included in the European Epinephrine Study Group's trial comparing high vs. standard doses of epinephrine. SETTING: Nine French university hospitals. PATIENTS: A total of 2,910 patients. INTERVENTIONS: Patients were successively and randomly assigned to receive repeated high doses (5 mg each) or standard doses (1 mg each) of epinephrine at 3-min intervals. MEASUREMENTS AND MAIN RESULTS: Return of spontaneous circulation, survival to hospital admission and discharge, and secondary outcome measures of 1-yr survival and neurologic outcome were recorded. In the trauma group, patients were younger (42 +/- 17 vs. 62 +/- 17 yrs, p <.001), presented with fewer witnessed out-of-hospital cardiac arrests (62.3% vs. 79.7%), and had fewer instances of ventricular fibrillation as the first documented pulseless rhythm (3.4% [95% confidence interval, 1.2-5.5%] vs. 17.3% [15.8-18.7%]). A return of spontaneous circulation was observed in 91 of 268 trauma patients (34.0% [28.3-39.6%]) compared with 797 of 2,642 medical patients (30.2% [28.4-31.9%]), and more trauma patients survived to be admitted to the hospital (29.9% [24.4-35.3%] vs. 23.5% [22.0-25.2%]). However, there was no significant difference between trauma and medical groups at hospital discharge (2.2% [0.5-4.0%] vs. 2.8% [2.1-3.4%]) and 1-yr survival (1.9% [0.3-3.5%] vs. 2.5% [1.9-3.1%]). Among patients who were discharged, a good neurologic status was observed in two trauma patients (33.3% [4.3-77.7%]) and 37 medical patients (50% [38.1-61.9%]). CONCLUSIONS: The survival and neurologic outcome of out-of-hospital cardiac arrest were not different between trauma and medical patients. This result suggests that, under the supervision of senior physicians, active resuscitation after out-of-hospital cardiac arrest is as important in trauma as in medical patients.

53 citations


Cites background from "Prehospital autotransfusion in life..."

  • ...Trauma care on the scene could include insertion of a central venous catheter (23) or chest tube (24) with autotransfusion (25), thoracotomy (26), control of hemostasis (stitch, epistaxis balloon), use of vasopressors (27), use of anesthetic agents, and definitive airway control (28)....

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Journal ArticleDOI
TL;DR: This review is based on a manuscript originally published in The Annals of the Royal College of Surgeons of England in 2012 and then edited by David I. Dickinson and David C. Dickinson in 2013.
Abstract: If you would like to submit a book to the Annals for review, please send two copies to: Publications Department, The Royal College of Surgeons of England, 35–43 Lincoln’s Inn Fields, London WC2A 3PE. Book reviews are published at the discretion of the editor.

51 citations


Journal ArticleDOI
TL;DR: Hemothorax blood contains significantly decreased coagulation factors and has lower hemoglobin when compared with venous blood.
Abstract: Background Autotransfusable shed blood has been poorly characterized in trauma and may have similarities to whole blood with additional benefits. Methods This was a prospective descriptive study of adult patients from whom ≥50 mL of blood was drained within the first 4 hours after chest tube placement. Pleural and venous blood samples were analyzed for coagulation, hematology, and electrolytes. Results Twenty-two subjects were enrolled in 9 months. The following measured coagulation factors of hemothorax were significantly depleted compared with venous blood: international normalized ratio (>9 in contrast to 1.1, P 180 in contrast to 28.5 seconds, P P P = .003), hemoglobin (9.3 in contrast to 11.8 g/dL, P = .004), and platelet count (53 in contrast to 174 K/μL, P Conclusions Hemothorax blood contains significantly decreased coagulation factors and has lower hemoglobin when compared with venous blood.

18 citations


Cites background from "Prehospital autotransfusion in life..."

  • ...vage and cell saver technology using anticoagulants and immediate prehospital autotransfusion of shed pleural blood.(18) Citing a lack of strong outcome data, the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists clinical practice guidelines do not recommend postoperative direct reinfusion of shed mediastinal blood in cardiac surgery patients....

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Journal ArticleDOI
TL;DR: The autologous transfusion of the patient’s shed blood collected through chest tubes for hemothorax was found to be safe without complications in this study and would help in designing larger prospective multicenter studies to determine whether this practice is truly safe and effective.
Abstract: BACKGROUNDThe practice of transfusing ones’ own shed whole blood has obvious benefits such as reducing the need for allogeneic transfusions and decreasing the need for other fluids that are typically used for resuscitation in trauma. It is not widely adopted in the trauma setting because of the conc

18 citations


Journal ArticleDOI
TL;DR: An evacuated hemothorax does not vary in composition significantly with time and is incoagulable alone, and Mixing studies with hemothsorax plasma increased coagulation, raising safety concerns.
Abstract: Background The evacuated hemothorax has been poorly described because it varies with time, it has been found to be incoagulable, and its potential effect on the coagulation cascade during autotransfusion is largely unknown. Methods This is a prospective descriptive study of adult patients with traumatic chest injury necessitating tube thoracostomy. Pleural and venous samples were analyzed for coagulation, hematology, and electrolytes at 1 to 4 hours after drainage. Pleural samples were also analyzed for their effect on the coagulation cascade via mixing studies. Results Thirty-four subjects were enrolled with a traumatic hemothorax. The following measured coagulation factors were significantly depleted compared with venous blood: international normalized ratio (>9 vs 1.1) (P 180 vs 24.5 seconds) (P Conclusions An evacuated hemothorax does not vary in composition significantly with time and is incoagulable alone. Mixing studies with hemothorax plasma increased coagulation, raising safety concerns.

12 citations


References
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Journal ArticleDOI
TL;DR: The preliminary results of the antishock trouser in this setting are encouraging and the treatment of bradycardia per se may be deleterious and atropine must be avoided in conscious patients with hemorrhagic shock and paradoxical bradyCardia.
Abstract: Two hundred and seventy-three acute hemorrhagic shocks were treated in 1984 in a pre-hospital emergency care unit. Twenty patients (7%) had a paradoxical bradycardia: they were conscious, 9 of them had an undetectable systolic arterial pressure with the sphygmomanometric method but the femoral pulse was still present. All of them recovered from bradycardia with fluid loading alone. The comparison between patients with paradoxical bradycardia and those with tachycardia showed that the former had more severe and rapid hemorrhages. During 1985, 7 new cases of acute hemorrhagic shock with paradoxical bradycardia were treated with an antishock trouser. These patients recovered from bradycardia more quickly (p less than 0.01) and with a less important fluid loading (p less than 0.01) than those previously treated without the antishock trouser. Two other patients were treated with atropine before antishock trouser inflation and experienced ventricular premature beats and one developed ventricular fibrillation. A paradoxical bradycardia can occur in hemorrhagic shock and denotes a rapid and severe hemorrhage requiring a massive and rapid fluid loading. The preliminary results of the antishock trouser in this setting are encouraging. The treatment of bradycardia per se may be deleterious and atropine must be avoided in conscious patients with hemorrhagic shock and paradoxical bradycardia.

69 citations



Journal ArticleDOI
TL;DR: No alteration in lipoproteins or elevation of plasma lipids was found with prolonged autotransfusion and no fat emboli were observed histologically.
Abstract: The effects of autotransfusion on cellular and other components of autologous blood were studied in forty adult dogs. An increase in free plasma hemoglobin and a decrease in hematocrit, red blood cells, and white blood cells were seen immediately after autotransfusion with canine blood exposed to the peritoneal cavity (group II) and blood collected in a siliconized beaker (group I). After autotransfusion, a significant decrease in platelets and a significantly higher free plasma hemoglobin level were noted in dogs in group II. In the five day period after autotransfusion the white blood cell and fibrinogen levels remained elevated whereas free plasma hemoglobin, hematocrit, red blood cell, and platelet levels returned to near normal. Prothrombin time, thrombin time, and partial thromboplastin time were within normal limits throughout the experimental period. Red blood cell survival after autotransfusion was found to be normal relative to controls. Screen filtration pressure was markedly elevated in blood suctioned from the abdominal cavity. Filtration with the autotransfusion reservoir filter resulted in a decrease in screen filtration pressure to a measurable but elevated level whereas screen filtration pressure returned to normal after Dacron wool filtration. No alteration in lipoproteins or elevation of plasma lipids was found with prolonged autotransfusion and no fat emboli were observed histologically. All dogs survived and showed no evidence of bleeding, thrombosis, or insult to pulmonary or other organ system function.

37 citations