INTRATHORACIC GREAT VESSEL INJURY RESULTING FROM BLUNT CHEST TRAUMA ASSOCIATED WITH POSTERIOR DISLOCATION OF THE STERNOCLAVICULAR JOINT

Three cases of great vessel injury resulting from blunt chest trauma and associated with posterior dislocation of the sternoclavicular joint are presented. The diagnosis and management including the surgical approach to this uncommon injury are discussed

Reduction in blood loss and blood use after cardiopulmonary bypass with high dose aprotinin (Trasylol)

The effect of high dose aprotinin (Trasylol) was evaluated in three groups of patients undergoing cardiopulmonary bypass. In a prospective, placebo-controlled, double-blind study, 80 patients having primary aorta-coronary bypass grafting received aprotinin (700 mg approximately) or saline placebo from the beginning of the procedure until skin closure. Standardized anesthetic, perfusion, and surgical techniques were used. The total loss from the thoracic drains was significantly reduced in the aprotinin group as compared with the loss in the placebo group (309 ± 133 ml versus 573 ± 166 ml, p < 0.01; mean ± standard deviation). There was a threefold difference in the total hemoglobin loss into the chest drains (aprotinin 12.0 2+ 12.6 gm versus placebo 37.7 ± 18.3 gm). Patients of the aprotinin group received remarkably less bank blood postoperatively: 13 units total compared with 75 units. Of the 40 patients in the aprotinin group, 32 received no bank blood compared with 2 of 37 patients in the placebo group. Venous hemoglobin levels preoperatively, on day 1, and on day 7 postoperatively did not differ between the groups. At day 7 the values were 13.1 ± 1.4 gm/dl versus 12.5 2+ 1.2 gm/dl in the aprotinin group and the placebo group, respectively. Platelet counts determined at fixed times perioperatively did not differ between the two groups. In contrast, template bleeding time measured in 32 study patients was distinctly different between groups, with a postoperative rise of 6.2 ± 2.1 minutes in the placebo group opposed to only 1.5 ± 1.1 minutes in the aprotinin group. In a separate, randomized comparative trial, 11 of 22 patients having reoperations through a previous median sternotomy received the same dose of aprotinin. Blood loss was reduced from 1509 ± 388 ml to 286 ±48 ml; p < 0.001 (mean ± standard error of the mean). Only four treated patients required transfusion (total of 5 units) whereas all patients in the control group received transfusions (total of 41 units). Since then, a further 24 patients undergoing reoperation have all been given aprotinin. Only four required transfusion (total of 5 units). A third group of 15 patients, all requiring operation for the acute complications of infective endocarditis, received high dose aprotinin treatment. The mean chest drainage was 388 ml. Only six patients received bank blood (total of 11 units). These results demonstrate that high dose aprotinin markedly reduces blood loss after cardioplulmonary bypass. It appears possible that aprotinin preserves platelet function without affecting platelet consumption under the conditions of extracorporeal circulation. Its use in cardiac operations offers a significant contribution toward blood conservation, especially in patients at high risk of bleeding

To transfuse, or not to transfuse: that is the question

Transfusion practice, like medical practice in its entirety, has evolved rapidly over the past few decades. Recent research on clinical outcomes has examined the impact of blood transfusion on critically ill patients, patients with trauma, those undergoing cardiac surgery, those experiencing acute coronary syndromes, oncology patients and others. Evidence is mounting of adverse outcomes associated with blood transfusion in a wide variety of clinical contexts. Here, we highlight the deficit in the current literature guiding transfusion practice, and call for an Australasian study to fill this deficit

Prevention of body temperature reduction (afterdrop) following hypothermic perfusion

This study investigated the possibility of preventing the postoperative reduction in body temperature (afterdrop) which followed a period of hypothermic cardiopulmonary bypass. In addition to warming all the infused fluids and inspired gases, the patients also had active warming by way of a system of hot water mattresses and limb jackets. In the eight male patients randomly allocated to the active treatment there were no significant changes on the central (aural) temperature in the five hours following the end of perfusion. The eight male control patients showed significant (

EFFECT OF APROTININ ON NEED FOR BLOOD TRANSFUSION AFTER REPEAT OPEN-HEART SURGERY

Of 22 patients undergoing repeat open-heart surgery through a previous median sternotomy wound 11 were randomised to receive the serine proteinase inhibitor aprotinin in high dosage (about 700 mg intravenously from the start of anaesthesia to the end of operation, depending on the length of the surgical procedure). Their mean blood loss was 286 ml compared with 1509 ml in the 11 control patients (