Evaluation of a Rapid Infusion System

Abstract

Operative cases where there is a potential for massive blood loss necessitates a system to rapidly warm and transfuse large volumes of blood over short periods of time. An in-house system in which both crystalloid solutions and blood products can be quickly added, warmed and available for infusion was developed to meet this need. The purpose of this study was to evaluate how blood products are affected when warmed and recirculated for an extended period of time. A recirculating rapid infusion system was assembled utilizing two filtered cardiotomy reservoirs, a centrifugal pump, a stainless steel blood heat exchanger, and 1/4 inch tubing, and applied in six adult orthotopic liver transplantations. The system was primed with 2 to 4 units each of fresh frozen plasma and packed red blood cells. The prime was recirculated and warmed to 37°C. Samples for blood gases, oxygen saturation, hematocrit, plasma free hemoglobin, sodium and potassium levels were drawn after initial priming and then every 30 minutes until additional blood products were added. Results show no significant change in pH (6.57 ± 0.21), pO2 (56 mmHg ± 23 mmHg), pCO2 (173 mmHg ± 138 mmHg), hematocrit (27% ± 8.7%) and plasma free hemoglobin values (125 mg/dl ± 9.4 mg/dl), following 3 hours of recirculation. However, potassium levels significantly decreased from 11.6 meq/L ± 2.6 meq/L to 10.0 meq/L ± 2.3 meq/L (p<0.05), sodium levels significantly increased from 144 meq/L ± 5.9 meq/L to 147 meq/L ± 5.3 meq/L (p<0.05) and oxygen saturations significantly increased from 59%± 9.1% to 70% ± 16% (p<0.05). The results demonstrate that this system can maintain banked blood warm and available for immediate infusion without significant deterioration for up to 3 hours.