Prehospital autotransfusion in life-threatening hemothorax
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.
About: This article is published in Chest.The article was published on 1988-03-01. It has received 38 citations till now. The article focuses on the topics: Autotransfusion & Hematocrit.
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5 citations
18 May 2007
TL;DR: In this article, the authors consider the problem of remplissage vasculaire, which reste cependant la pierre angulaire de son traitement, une hypovolemie absolue ou relative and presque constamment presente.
Abstract: Le traitement d’un etat de choc necessite la connaissance de son mecanisme physiopathologique et comporte toujours une part etiologique. Le remplissage vasculaire reste cependant la pierre angulaire de son traitement, une hypovolemie absolue ou relative etant presque constamment presente. L’utilisation des solutes de remplissage vasculaire necessite une connaissance precise de leurs caracteristiques, de leurs avantages et de leurs effets secondaires. L’utilisation des cristalloides est limitee par leur faible persistance intravasculaire et la surcharge hydrosodee extravasculaire induite par leur utilisation. Les colloides ont donc une place majeure dans l’etat de choc avere. La place de l’albumine humaine est actuellement tres restreinte. Les indications des solutes sales hypertoniques ont ete recemment definies. En medecine d’urgence, il convient de connaitre precisement les objectifs cliniques et la surveillance du remplissage vasculaire. De la meme maniere, les autres techniques de correction volemique, position du patient, autotransfusion et utilisation du pantalon antichoc, doivent etre connues.
5 citations
TL;DR: Dans cette seconde situation, une serie prospective portant sur 30 patients a etudie les possibilites du dispositif ConstaVac™, le seul appareil, en circuit ferme, permettant de drainer et de retransfuser simultanement le patient.
Abstract: The technique of autotransfusion with blood drained from a haemothorax has been described nearly 80 years ago. The shed blood is easy to collect and is incoagulable. This technique as two indications: lifesaving autotransfusion in the prehospital phase and blood saving and/or transfusional safety at hospital arrival. This prospective study assessed its value as well as the advantages and disadvantages of the ConstaVac system in 30 patients suffering from haemothorax. This apparatus consists of a 800 mL collecting reservoir on a support equipped with an electric aspirator and a battery. The collected blood is transferred into a reinfusion bag while remaining in a closed circuit. The retransfused volume was 685 +/- 430 mL, representing 80% of the collected volume. The retransfusion took place in less than four hours. The patients with an isolated haemothorax did not receive any homologous blood. Only one technical problem occurred, related to the excessive volume of the haemothorax. The shed blood has decreased content of platelets, fibrinogen, and is incoagulable. Moreover, it is hemolyzed. Its hematocrit is lower than the patient's one. On the other hand, the concentration of 2,3 DPG remains normal. These modifications have no detrimental consequences on the patients as long as the autotransfused volume does not exceed two litres. Infectious problems are rare. Handling requires strict asepsis. The ConstaVac system is marketed for postoperative autotransfusion. It is compact, self-contained and very easy to use. It is the only system able of ensuring blood drainage and retransfusion simultaneously, without requiring any opening of the circuit.(ABSTRACT TRUNCATED AT 250 WORDS)
3 citations
TL;DR: L’eventualita di lesioni mediastiniche (istmo dell’aorta) deve essere sistematicamente considerata nel bilancio lesionale iniziale quando il trauma ha una cinetica elevata.
3 citations
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102 citations
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.
72 citations
49 citations
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
Journal Article•
36 citations