Rapid infusion system for neurosurgical treatment of massive intraoperative hemorrhage.

Published

Journal Article

Using an illustrative case of severe closed head injury that resulted in a posterior fossa epidural hematoma (EDH) and supratentorial epidural/subdural hematomas (SDH), the massive blood losses associated with operative repair of the torn sigmoid sinus and the significant fluid losses associated with refractory diabetes insipidus were treated by the intraoperative use of the Rapid Infusion System (RIS, Haemonetics). The RIS can rapidly infuse warm blood, crystalloid, or colloid at rates up to 1.5 L/min, thereby limiting the commonly associated hypotension, hypothermia, and coagulopathies. During the suboccipital craniectomy for evacuation of the EDH and repair of the sigmoid sinus, the patient required 18 units of blood replacement secondary to a large tear in the sigmoid sinus. During a separate craniotomy for evacuation of the SDH, the patient also developed diabetes insipidus, which increased the operative fluid replacement to 39 L. Despite these massive blood and fluid losses, the RIS limited the hypotension to less than 2 min and prevented hypothermia and the frequently associated coagulopathies. When used in a neurosurgical setting associated with massive blood and/or fluid losses, the RIS accomplishes three important objectives: (1) rapid infusion of intravenous fluids for maintaining perfusion pressure, (2) rapid warming of fluids despite high intravenous infusion rates of cold crystalloids, thereby preventing intraoperative hypothermia, and (3) continuous monitoring of infusion rates and totals.

Full Text

Duke Authors

Cited Authors

  • Haglund, MM; Grady, MS; Kanev, PM; Pavlin, EG; Mayberg, TA; Winn, HR

Published Date

  • October 1994

Published In

Volume / Issue

  • 11 / 5

Start / End Page

  • 623 - 627

PubMed ID

  • 7861453

Pubmed Central ID

  • 7861453

International Standard Serial Number (ISSN)

  • 0897-7151

Digital Object Identifier (DOI)

  • 10.1089/neu.1994.11.623

Language

  • eng

Conference Location

  • United States