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New device for temporary hemorrhage control in penetrating injuries to the ventricles
  1. Joao Baptista Rezende-Neto1,
  2. Howard Leong-Poi2,
  3. Sandro Rizoli3,
  4. Andrew Beckett4
  1. 1Department of Surgery, St. Michael's Hospital University of Toronto, Toronto, Ontario, Canada
  2. 2Department of Medicine, St. Michael's Hospital University of Toronto, Toronto, Ontario, Canada
  3. 3Department of Surgery, Division of General Surgery, University of Toronto, St. Michael's Hospital University of Toronto, Toronto, Ontario, Canada
  4. 4Department of Surgery, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
  1. Correspondence to Dr Joao Baptista Rezende-Neto; rezendenetoj{at}smh.ca

Abstract

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.

  • Cardiac surgical procedures
  • Cardiac Tamponade
  • traumatic hemorrhage
  • injury and trauma

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/

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