Yost Gardner, Collofello Brandon, Goba Gelila, Koch Abigail, Harrington Amanda, Esmailbeigi Hananeh, Robinson Nuriya, Kutz-McClain Pamela, Geller Stacie, Dobiesz Valerie
a College of Medicine , University of Illinois at Chicago , IL , USA.
b Department of Obstetrics and Gynecology , University of Illinois , Chicago , IL , USA.
J Med Eng Technol. 2017 Oct;41(7):515-521. doi: 10.1080/03091902.2017.1364308. Epub 2017 Aug 29.
Postpartum haemorrhage (PPH) is an obstetric emergency caused by excessive blood loss after delivery, which is the leading cause of maternal mortality worldwide. PPH can lead to volume depletion, hypovolemic shock, anaemia and ultimately death. The prevalence of PPH is disproportionately higher in low resource settings where there is limited access to skilled medical care and safe blood supplies. Current management strategies target both prevention and treatment of PPH however no alternatives currently exist to address the lack of safe blood supplies which are considered essential in emergency obstetrical care. Autotransfusion is used to salvage blood loss in a variety of clinical settings but has never been used in the context of vaginal delivery. We describe the development and testing of a novel device for the collection, filtration and autotransfusion of blood lost due to PPH. The prototype device is inexpensive and easily operated so that it may be practically deployed in low resource settings. The device is comprised of a blood collection drape, a pump apparatus, three leukocyte reduction filters and a reservoir for filtered blood. Preliminary testing demonstrates efficacy of microbial load reduction of up to 97.3%. To reduce cost and improve safety, the device is modular in design such that the drape, tubing, filters and transfusion bag may be stored sterile, used once and discarded; while the pump apparatus may be used indefinitely without the need for sterilisation. Preliminary results indicate the device confers a low cost and potentially effective means of collecting, pumping, filtering and returning blood to a patient following PPH in settings that lack safe blood supplies. This device shows promise as a method of stabilising patients suffering of PPH in low resource settings until definitive treatment is rendered with the ultimate goal of reducing maternal mortality globally.
产后出血(PPH)是一种分娩后因失血过多导致的产科急症,是全球孕产妇死亡的主要原因。产后出血可导致血容量减少、低血容量性休克、贫血并最终导致死亡。在医疗资源匮乏、难以获得熟练医疗护理和安全血液供应的地区,产后出血的患病率尤其高。目前的管理策略旨在预防和治疗产后出血,然而,目前尚无替代方法来解决安全血液供应短缺的问题,而安全血液供应在产科急诊护理中被认为至关重要。自体输血在各种临床环境中用于挽救失血,但从未用于阴道分娩的情况。我们描述了一种用于收集、过滤和自体回输产后出血血液的新型装置的研发和测试。该原型装置价格低廉且易于操作,因此可实际应用于资源匮乏地区。该装置由一个采血单、一个泵装置、三个白细胞滤器和一个过滤血液储存器组成。初步测试表明,该装置的微生物负荷降低率高达97.3%。为了降低成本并提高安全性,该装置采用模块化设计,采血单、管道、滤器和输血袋可无菌储存,使用一次后丢弃;而泵装置可无限期使用,无需消毒。初步结果表明,在缺乏安全血液供应的情况下,该装置为产后出血患者收集、泵送、过滤和回输血液提供了一种低成本且可能有效的方法。该装置有望成为在资源匮乏地区稳定产后出血患者病情的一种方法,直至进行最终治疗,最终目标是降低全球孕产妇死亡率。