LETTERS TO THE EDITOR: Letters & Announcements
To the Editor:
We would like to communicate a technique that shows promise in treating circulatory arrest associated coagulopathy. We perform many cases necessitating hypothermic circulatory arrest (HCA). Previously, the rule was that these patients would develop severe coagulopathy and require massive transfusion. We still perform HCA cases, but coagulopathy is now the exception. We believe that use of a rapid transfusion device is responsible for much of the progress we have achieved.
Our liver transplantation team uses a rapid transfusion device to manage intraoperative coagulopathy. We applied this concept to patients undergoing HCA. Our results were positive and we now use the device for all such cases. We performed a study comparing blood product usage prior to use of this device, with current cases, and observed definite trends toward lower blood product consumption.
Our protocol includes use of the Belmont FMS fluid delivery system (Belmont Instruments, Billerica, MA), which delivers warm fluid up to 500cc/min. We deliver red blood cells and plasma with the device, and additional fluids though a separate IV. The device is inexpensive, and easy to use. Hence, we feel that use of this device is not only justified, but deserves more widespread use and investigation.
Patrick E. Benedict, MD
Steven Lubitz, MD