Prehospital autotransfusion in life-threatening hemothorax.

ABSTRACT

Eighteen patients with life-threatening traumatic hemothorax received prehospital autotransfusion using a simple new device. During transfer to the hospital, they received 3.9 +/- 0.5 L of colloid fluid and 4.1 +/- 0.6 L of autotransfused blood, without anticoagulation. Hemorrhagic blood was not coagulable, had a hematocrit of 20 +/- 4 percent, few platelets, and low fibrinogen levels. Five patients died from irreversible hemorrhagic shock. Thirteen patients were alive upon admission to the hospital, underwent emergency surgery, and were discharged alive. During autotransfusion, hematocrit decreased from 24 +/- 3 to 19 +/- 3 percent, and systolic arterial pressure increased from 78 +/- 11 to 88 +/- 12 mm Hg. Upon admission to the hospital, platelet count was 90,800 +/- 21,400/cu mm, prothrombin time 48 +/- 3 percent, partial thromboplastin time 197 +/- 18 percent, plasma free hemoglobin levels 21 +/- 7 mg/100 ml, and serum potassium levels 3.6 +/- 0.5 mmol/L. No serious complication could be related to autotransfusion considered to be crucial to patients' survival. The preliminary results of this study suggest that autotransfusion might be developed in the prehospital setting since it appears simple and safe, and represents the only hope of survival for patients with life-threatening hemothorax.