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.
Citations
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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.
60 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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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.
54 citations
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
24 citations
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.
22 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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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.
13 citations
References
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TL;DR: The three reports given here of the use of autotransfusion in cases of hemothorax are sufficiently interesting for presentation.
Abstract: The reinfusion of extravasated blood is rapidly becoming an accepted procedure. A careful search of the literature to date has revealed only one reported case of autotransfusion of blood from the pleural cavity. Therefore we believe that the three reports given here of the use of autotransfusion in cases of hemothorax are sufficiently interesting for presentation. Autotransfusion, i. e., the reinfusion of the patient's own blood, has obtained increasing attention during the past few years following the reports in 1914 of Johannes Thies 1 of Leipzig, who reinjected blood obtained from the abdominal cavity in cases of ruptured tubal pregnancy. However, according to Kubanyi 2 of Hungary, the idea appears to have originated in England, as William Highmore 3 in 1874 suggested its use, and in 1885 there is a report of its actual application by A. G. Miller, 4 who collected and reinjected with gratifying results blood lost during
34 citations
TL;DR: The volume of blood obtained with this technique was disappointingly low, and because of the unknown alteration of blood components while the blood remained in the pleural space, and the concommitant effects upon the recipient after autotransfusion, the following investigation was undertaken in 1966.
25 citations
20 citations
5 citations
01 Jan 1987
TL;DR: Improvement of pre-hospital management of HS has concerned physicians for several years, but few definitive measures other than rapid transport, positioning of the patient, or direct pressure for control of haemorrhage have been suggested.
Abstract: Haemorrhagic shock (HS) is clearly a major health problem. HS is usually related to trauma that affects primarily young people and accounts for more years of lost life than cancer and heart disease. Exsanguination, HS, and cardiac arrest related to extreme hypovolemia are among the most challenging conditions encountered in pre-hospital medical practice. Improvement of pre-hospital management of HS has concerned physicians for several years. Nevertheless, few definitive measures other than rapid transport, positioning of the patient, or direct pressure for control of haemorrhage have been suggested. The Medical Anti-Shock Trousers (MAST) have been advocated only since 1973 for civilian pre-hospital emergency care [1].
5 citations