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New device for temporary hemorrhage control in penetrating injuries to the ventricles
BACKGROUND: The best way to control hemorrhage from cardiac injuries is through digital occlusion followed by suture. However, this is difficult to accomplish in the emergency department (ED) setting. Generally, temporary control is obtained in advance of definitive treatment in the operating room....
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5891694/ https://www.ncbi.nlm.nih.gov/pubmed/29766056 http://dx.doi.org/10.1136/tsaco-2016-000012 |
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author | Rezende-Neto, Joao Baptista Leong-Poi, Howard Rizoli, Sandro Beckett, Andrew |
author_facet | Rezende-Neto, Joao Baptista Leong-Poi, Howard Rizoli, Sandro Beckett, Andrew |
author_sort | Rezende-Neto, Joao Baptista |
collection | PubMed |
description | BACKGROUND: The best way to control hemorrhage from cardiac injuries is through digital occlusion followed by suture. However, this is difficult to accomplish in the emergency department (ED) setting. Generally, temporary control is obtained in advance of definitive treatment in the operating room. Despite safety and efficacy concerns, balloon Foley catheter insertion through the injury is still an option following ED thoracotomies. We developed a new device for temporary hemorrhage control in cardiac injuries and compared it to the Foley. METHODS: 6 adult swine (n=6) underwent full-thickness (1.5 cm) injury along the longitudinal axis of the right ventricle (RV). After 5 s of bleeding, hemorrhage control was attempted with either the device or the Foley, and blood loss quantified. Subsequently, the wound was sutured and mean arterial pressure was restored to baseline with lactated Ringer's infusion. Subsequently, another injury 2 cm apart in the same ventricle was managed with apparatus not employed in the first injury. The same followed in the LV totaling 4 injuries per animal, 2 in each ventricle. Intraoperative echocardiogram, laboratory test and final wound sizes assessed. RESULTS: The device resulted in less bleeding than the Foley; RV 58.7±11.3 vs 147.7±30.9 mL, LV 81.7±11.9 vs 187.5±40.3 mL (p<0.05). Percent change in tricuspid regurgitation was less with the device than FO, 66.6% vs 400%. Mitral regurgitation increased 16% with Foley, but remained unchanged with the device. Changes in stroke volume and LV ejection fraction were less with the device than with Foley; SV 2.09% vs 12.48%, left ventricular ejection fraction 0.46% vs 5.45%. Foley insertion enlarged the wounds. Platelet count, complete blood count, prothrombin time, activated prothrombin time and fibrinogen decreased, whereas troponin and lactate increased compared with baseline, underscoring the magnitude of shock. CONCLUSIONS: Cardiac hemorrhage was effectively controlled with the new device. The low-profile collapsible blocking membrane interfered less with cardiac function than did the balloon of the Foley, an important asset in the context of shock. |
format | Online Article Text |
id | pubmed-5891694 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-58916942018-05-14 New device for temporary hemorrhage control in penetrating injuries to the ventricles Rezende-Neto, Joao Baptista Leong-Poi, Howard Rizoli, Sandro Beckett, Andrew Trauma Surg Acute Care Open Original Article BACKGROUND: The best way to control hemorrhage from cardiac injuries is through digital occlusion followed by suture. However, this is difficult to accomplish in the emergency department (ED) setting. Generally, temporary control is obtained in advance of definitive treatment in the operating room. Despite safety and efficacy concerns, balloon Foley catheter insertion through the injury is still an option following ED thoracotomies. We developed a new device for temporary hemorrhage control in cardiac injuries and compared it to the Foley. METHODS: 6 adult swine (n=6) underwent full-thickness (1.5 cm) injury along the longitudinal axis of the right ventricle (RV). After 5 s of bleeding, hemorrhage control was attempted with either the device or the Foley, and blood loss quantified. Subsequently, the wound was sutured and mean arterial pressure was restored to baseline with lactated Ringer's infusion. Subsequently, another injury 2 cm apart in the same ventricle was managed with apparatus not employed in the first injury. The same followed in the LV totaling 4 injuries per animal, 2 in each ventricle. Intraoperative echocardiogram, laboratory test and final wound sizes assessed. RESULTS: The device resulted in less bleeding than the Foley; RV 58.7±11.3 vs 147.7±30.9 mL, LV 81.7±11.9 vs 187.5±40.3 mL (p<0.05). Percent change in tricuspid regurgitation was less with the device than FO, 66.6% vs 400%. Mitral regurgitation increased 16% with Foley, but remained unchanged with the device. Changes in stroke volume and LV ejection fraction were less with the device than with Foley; SV 2.09% vs 12.48%, left ventricular ejection fraction 0.46% vs 5.45%. Foley insertion enlarged the wounds. Platelet count, complete blood count, prothrombin time, activated prothrombin time and fibrinogen decreased, whereas troponin and lactate increased compared with baseline, underscoring the magnitude of shock. CONCLUSIONS: Cardiac hemorrhage was effectively controlled with the new device. The low-profile collapsible blocking membrane interfered less with cardiac function than did the balloon of the Foley, an important asset in the context of shock. BMJ Publishing Group 2016-07-24 /pmc/articles/PMC5891694/ /pubmed/29766056 http://dx.doi.org/10.1136/tsaco-2016-000012 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ |
spellingShingle | Original Article Rezende-Neto, Joao Baptista Leong-Poi, Howard Rizoli, Sandro Beckett, Andrew New device for temporary hemorrhage control in penetrating injuries to the ventricles |
title | New device for temporary hemorrhage control in penetrating injuries to the ventricles |
title_full | New device for temporary hemorrhage control in penetrating injuries to the ventricles |
title_fullStr | New device for temporary hemorrhage control in penetrating injuries to the ventricles |
title_full_unstemmed | New device for temporary hemorrhage control in penetrating injuries to the ventricles |
title_short | New device for temporary hemorrhage control in penetrating injuries to the ventricles |
title_sort | new device for temporary hemorrhage control in penetrating injuries to the ventricles |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5891694/ https://www.ncbi.nlm.nih.gov/pubmed/29766056 http://dx.doi.org/10.1136/tsaco-2016-000012 |
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