Internal Medicine, NYU Langone Health, New York, New York.
Electrophysiology, New York University Langone Medical Center, New York, New York.
J Cardiovasc Electrophysiol. 2020 Jun;31(6):1379-1384. doi: 10.1111/jce.14462. Epub 2020 Apr 23.
Acute hemopericardium during cardiac electrophysiology (EP) procedures may result in significant blood loss and is the most common cause of procedure-related death. Matched allogeneic blood is often not immediately available. The feasibility and safety of direct autotransfusion in cardiac electrophysiology patients requiring emergency pericardiocentesis is unknown.
We retrospectively analyzed records of patients undergoing EP procedures at a single, tertiary care medical center who had procedure-related acute hemopericardium requiring emergency pericardiocentesis during a 3-year period. Procedure details, transfusion volumes, and clinical outcomes of patients who received direct autotransfusion of aspirated pericardial blood via a femoral venous sheath were compared to those of patients who did not receive direct autotransfusion.
During the study period, 10 patients received direct autotransfusion (group 1) and outcomes were compared with those of 14 control patients who did not receive direct autotransfusion (group 2). The volume of aspirated pericardial blood was similar in groups 1 and 2 (1.6 ± 0.7 L vs 1.3 ± 1.0 L, respectively; P = .52). Amongst patients with aspirated volumes <1 L, group 1 patients (n = 4) were less likely than group 2 patients (n = 8) to require allotransfusion (0% vs 75%, P = .02). Amongst patients with aspirated volume ≥1 L, group 1 patients (n = 6) required fewer units of red cell allotransfusion than group 2 patients (n = 6) (1.5 ± 0.8 units vs 4.3 ± 2.0 units, P = .01). No procedural complications related to direct autotransfusion occurred.
Direct autotransfusion following emergency pericardiocentesis during electrophysiology procedures requiring systemic anticoagulation is feasible and safe. The utilization of direct autotransfusion may eliminate or reduce the need for allotransfusion.
心脏电生理（EP）程序期间发生的急性血心包可能导致大量失血，是程序相关死亡的最常见原因。匹配的同种异体血液通常不能立即获得。在需要紧急心包穿刺的心电生理患者中，直接自体输血的可行性和安全性尚不清楚。
我们回顾性分析了在 3 年内于一家三级医疗中心接受 EP 程序的患者的记录，这些患者在 EP 程序期间发生了与程序相关的急性血心包，需要紧急心包穿刺。比较了通过股静脉鞘直接抽吸心包血进行直接自体输血的患者（组 1）和未接受直接自体输血的患者（组 2）的程序细节、输血量和临床结果。
在研究期间，有 10 名患者接受了直接自体输血（组 1），并与未接受直接自体输血的 14 名对照患者（组 2）的结果进行了比较。组 1 和组 2 患者抽吸的心包血量相似（分别为 1.6±0.7 L 和 1.3±1.0 L，P=0.52）。在抽吸量<1 L 的患者中，组 1 患者（n=4）比组 2 患者（n=8）更不可能需要异体输血（0% vs 75%，P=0.02）。在抽吸量≥1 L 的患者中，组 1 患者（n=6）需要的红细胞异体输血单位数少于组 2 患者（n=6）（1.5±0.8 单位 vs 4.3±2.0 单位，P=0.01）。直接自体输血后未发生与程序相关的并发症。
在需要全身抗凝的 EP 程序中，紧急心包穿刺后直接自体输血是可行且安全的。直接自体输血的使用可以消除或减少异体输血的需求。
