Rezende-Neto Joao Baptista, Leong-Poi Howard, Rizoli Sandro, Beckett Andrew
Department of Surgery, St. Michael's Hospital University of Toronto, Toronto, Ontario, Canada.
Department of Medicine, St. Michael's Hospital University of Toronto, Toronto, Ontario, Canada.
Trauma Surg Acute Care Open. 2016 Jul 24;1(1):e000012. doi: 10.1136/tsaco-2016-000012. eCollection 2016.
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.
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.
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.
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.
控制心脏损伤出血的最佳方法是通过手指压迫止血，随后进行缝合。然而，在急诊科环境中这很难做到。一般来说，在手术室进行确定性治疗之前会先进行临时控制。尽管存在安全性和有效性方面的担忧，但在急诊开胸术后，通过损伤处插入气囊 Foley 导管仍是一种选择。我们开发了一种用于临时控制心脏损伤出血的新装置，并将其与 Foley 导管进行了比较。
6 只成年猪（n = 6）沿右心室（RV）纵轴接受全层（1.5 厘米）损伤。出血 5 秒后，尝试用该装置或 Foley 导管控制出血，并对失血量进行量化。随后，缝合伤口，并用乳酸林格氏液输注将平均动脉压恢复到基线水平。随后，在同一心室中相距 2 厘米处造成另一个损伤，使用第一次损伤时未使用的器械进行处理。左心室也照此进行，每只动物共造成 4 处损伤，每个心室 2 处。术中进行超声心动图检查、实验室检测并评估最终伤口大小。
该装置导致的出血比 Foley 导管少；右心室分别为 58.7±11.3 毫升和 147.7±30.9 毫升，左心室分别为 81.7±11.9 毫升和 187.5±40.3 毫升（p < 0.05）。该装置导致三尖瓣反流的百分比变化比 Foley 导管小，分别为 66.6%和 400%。Foley 导管使二尖瓣反流增加了 16%，而该装置使其保持不变。与 Foley 导管相比，该装置导致的每搏输出量和左心室射血分数变化更小；每搏输出量分别为 2.09%和 12.48%，左心室射血分数分别为 0.46%和 5.45%。插入 Foley 导管会扩大伤口。与基线相比，血小板计数、全血细胞计数、凝血酶原时间、活化凝血酶原时间和纤维蛋白原降低，而肌钙蛋白和乳酸增加，这突出了休克的严重程度。
新装置有效控制了心脏出血。低轮廓可折叠阻塞膜对心脏功能的干扰比 Foley 导管的气囊小，这在休克情况下是一项重要优势。
