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Rezende-Neto JB, Leong-Poi H, Rizoli S, et al. New device for temporary hemorrhage control in penetrating injuries to the ventricles. Trauma Surg Acute Care Open. 2016;1(1):e000012doi: 10.1136/tsaco-2016-000012.
Rezende-Neto, J. B., Leong-Poi, H., Rizoli, S., & Beckett, A. (2016). New device for temporary hemorrhage control in penetrating injuries to the ventricles. Trauma surgery & acute care open, 1(1), e000012. https://doi.org/10.1136/tsaco-2016-000012
Rezende-Neto, Joao Baptista, et al. "New device for temporary hemorrhage control in penetrating injuries to the ventricles." Trauma surgery & acute care open vol. 1,1 (2016): e000012. doi: https://doi.org/10.1136/tsaco-2016-000012
Rezende-Neto JB, Leong-Poi H, Rizoli S, Beckett A. New device for temporary hemorrhage control in penetrating injuries to the ventricles. Trauma Surg Acute Care Open. 2016 Jul 24;1(1):e000012. doi: 10.1136/tsaco-2016-000012. eCollection 2016. PMID: 29766056; PMCID: PMC5891694.
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Trauma Surg Acute Care Open. 2016 Jul 24;1(1):e000012. doi: 10.1136/tsaco-2016-000012. eCollection 2016.

New device for temporary hemorrhage control in penetrating injuries to the ventricles.

Trauma surgery & acute care open

Joao Baptista Rezende-Neto, Howard Leong-Poi, Sandro Rizoli, Andrew Beckett

Affiliations

  1. Department of Surgery, St. Michael's Hospital University of Toronto, Toronto, Ontario, Canada.
  2. Department of Medicine, St. Michael's Hospital University of Toronto, Toronto, Ontario, Canada.
  3. Department of Surgery, Division of General Surgery, University of Toronto, St. Michael's Hospital University of Toronto, Toronto, Ontario, Canada.
  4. Department of Surgery, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.

PMID: 29766056 PMCID: PMC5891694 DOI: 10.1136/tsaco-2016-000012

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.

Keywords: Cardiac Tamponade; Cardiac surgical procedures; injury and trauma; traumatic hemorrhage

Conflict of interest statement

Competing interests: JBR-N has filed a provisional patent application for the device described in this study.

References

  1. Wounds. 2008 Aug;20(8):219-20 - PubMed
  2. Surg Gynecol Obstet. 1989 Sep;169(3):247-50 - PubMed
  3. Arch Emerg Med. 1993 Dec;10(4):385-6 - PubMed
  4. World J Surg. 2006 Jul;30(7):1258-64 - PubMed
  5. Injury. 2001 Sep;32(7):533-43 - PubMed
  6. J Clin Invest. 1991 Jan;87(1):247-54 - PubMed
  7. Injury. 2009 Sep;40(9):919-27 - PubMed
  8. J Med Biogr. 2012 Feb;20(1):32-4 - PubMed
  9. J Trauma. 1986 Apr;26(4):400-2 - PubMed
  10. Surg Clin North Am. 1996 Aug;76(4):685-724 - PubMed
  11. Circulation. 1989 Jun;79(6):1226-36 - PubMed
  12. J Trauma. 1998 Jun;44(6):1073-82 - PubMed
  13. Eur J Cardiothorac Surg. 2005 Sep;28(3):435-42 - PubMed
  14. Interact Cardiovasc Thorac Surg. 2005 Jun;4(3):212-5 - PubMed
  15. World J Emerg Surg. 2006 Mar 24;1:4 - PubMed
  16. Turk J Med Sci. 2014;44(6):935-40 - PubMed
  17. J Am Coll Surg. 1998 Jan;186(1):24-34 - PubMed
  18. Br J Surg. 1997 Dec;84(12):1737-40 - PubMed
  19. Eur J Cardiothorac Surg. 2006 Oct;30(4):584-91 - PubMed
  20. Ann Thorac Surg. 1991 May;51(5):711-5; discussion 715-6 - PubMed
  21. J Trauma. 1999 Mar;46(3):441-3; discussion 443-4 - PubMed
  22. J Emerg Med. 1996 Sep-Oct;14(5):615-8 - PubMed
  23. J Trauma. 1986 Sep;26(9):821-5 - PubMed
  24. J Trauma. 1993 May;34(5):711-5; discussion 715-6 - PubMed
  25. J Trauma. 1983 Dec;23(12):1034-41 - PubMed
  26. J Trauma. 1993 May;34(5):717-25; discussion 725-7 - PubMed
  27. Tenn Med. 1996 Jul;89(7):249-51 - PubMed
  28. J Trauma. 1998 Aug;45(2):366-70 - PubMed
  29. J Trauma. 2000 Apr;48(4):587-90; discussion 590-1 - PubMed

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