Autologous blood reinfusion during iatrogenic acute hemorrhagic cardiac tamponade: Safety and feasibility in a cohort of 30 patients

Fiocca, Luigi; Cereda, Alberto; Bernelli, Chiara; Canova, Paolo; Serino, Federica; Niglio, Tullio; Musumeci, Giuseppe; Guagliumi, Giulio; Vassileva, Angelina; Senni, Michele; Valsecchi, Orazio

doi:10.1002/ccd.27784

Cited by 18 publications

(15 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In previous studies, the need for surgery ranged from 13% to 56% of cases. In our cohort, 50% of patients required urgent surgical management, mostly for persistent bleeding, with a mean blood volume of 1528 ± 840 mL, which is particularly high compared to the study by Fiocca, in which in the emergent cardiac surgery rate was lower (16.7%, n = 5/30 vs 50%) for a much lower volume of pericardial blood reinfused (407 ± 210 vs 1528 ± 840 mL) but with a higher postprocedure mortality (10% vs 7%) . Direct AutoBT was performed routinely by an experienced team in this single‐center study and mainly in the context of ACT during percutaneous coronary intervention.…”

Section: Discussionsupporting

confidence: 70%

“…Blood clotting may occur during AutoBT, but the incidence of procedure‐related thrombosis was very low, probably due to the high level of anticoagulation maintained during electrophysiological procedures. The fibrinolytic property of the pericardium may also reduce the risk of thrombosis during AutoBT .…”

Section: Discussionmentioning

confidence: 99%

“…This approach is based on the direct transfusion of the patient's own blood removed from the pericardial space. The use of AutoBT has been reported in several medical centers and although it was mentioned in the latest pericardial disease management guidelines, this technique has not been routinely adopted due to the reluctance of physicians to reinfuse unwashed blood and the lack of evidence concerning the safety of this procedure. The objective of this retrospective study was to assess the feasibility, safety, and efficacy of direct AutoBT as a salvage therapy for the treatment of ACT in interventional electrophysiology procedure.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Management of acute cardiac tamponade by direct autologous blood transfusion in interventional electrophysiology

Beyls

Hermida

Duchâteau

et al. 2019

Cardiovasc electrophysiol

View full text Add to dashboard Cite

Aims: Acute cardiac tamponade (ACT) is the most common life-threatening complication of interventional electrophysiology. Urgent drainage by percutaneous pericardiocentesis and anticoagulation reversal are required. Immediate direct transfusion of the blood volume aspirated from the pericardial space to the patient has been rarely described. This study was designed to assess the efficacy and safety of immediate direct autologous blood transfusion (AutoBT).Methods: A retrospective case series of direct AutoBT performed for ACT was collected.Urgent drainage by percutaneous pericardiocentesis and immediate direct AutoBT were performed to achieve hemodynamic stabilization without a cell-saver system.Results: Twenty-two electrophysiology centers were contacted to participate in the case series. Fourteen centers reported not to use direct AutoBT. Three centers reported using direct AutoBT with the cell-saver system. Fourteen cases of immediate direct AutoBT without cell-saver system were included from the five remaining centers.Electrophysiological procedures were performed for ventricular tachycardia (n = 5), atrial fibrillation (n = 5), atrial tachycardia (n = 2), left accessory pathway (n = 1), and premature ventricular contraction (n = 1) with transseptal (n = 9), retroaortic (n = 4), and/or epicardial access (n = 4). Pericardial drainage was performed by percutaneous pericardiocentesis for 13 patients and via the transseptal sheath for one patient. Surgical hemostasis was required for seven patients. The mean volume of autologous blood directly transfused was 1207 ± 963 mL. Direct AutoBT permitted to resume the procedure in four patients. No major complication related to the use of AutoBT occurred. Conclusion: Direct AutoBT without a cell-saver system is a feasible, safe, and useful technique for salvage therapy in ACT in interventional electrophysiology. K E Y W O R D S autotransfusion, catheter ablation, interventional electrophysiology, tamponade Josselin Duchateau

show abstract

Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Management of acute cardiac tamponade by direct autologous blood transfusion in interventional electrophysiology

Beyls

Hermida

Duchâteau

et al. 2019

Cardiovasc electrophysiol

View full text Add to dashboard Cite

show abstract

“…Autotransfusion should be taken into account in patients with persistent bleeding despite concerns have been raised due to the potential to induce hemolysis, coagulation abnormalities or possible infections, especially when large quantities are re-infused. However this procedure was shown to be safe and effective in a recent review including 30 consecutive patients [7] . • Pain management and eventually sedation.…”

Section: Coronary Perforationmentioning

confidence: 99%

Chronic total occlusion percutaneous coronary intervention complications: prevention and management

Colombo¹,

Bernardi²,

Garbo³

2019

View full text Add to dashboard Cite

Percutaneous coronary intervention (PCI) of coronary chronic total occlusions (CTO) still represents a challenge in the field of interventional cardiology. Despite the rate of peri-procedural complications has decreased over the years, it remains higher than in non-CTO PCI. Coronary perforations are among the most common and serious complications. Furthermore CTO recanalization carries a risk of unique and specific complications such as donor vessel injury and equipment loss or entrapment. Other infrequent complications of non-CTO PCI such as contrast induced renal dysfunction and radiation skin injury, assume more relevance in this subset given the length and complexity of these procedures. Operators facing CTO percutaneous treatment should be aware of the potential complications and the available strategies for prevention and management, to achieve procedural success.

show abstract

“…The feasibility of direct autotransfusion of aspirated pericardial blood into the femoral artery or the femoral vein has been reported in case‐series of hemopericardium and tamponade related to coronary interventions, 11‐13 and catheter ablation, 14‐17 but it has not yet been studied in a systematic fashion with comparison against patients not receiving autotransfusion. In this study, we aimed to assess the safety and feasibility of direct autotransfusion in anticoagulated patients requiring emergency pericardiocentesis during EP procedures including left atrial appendage occlusion complicated with acute hemopericardium and cardiac tamponade.…”

Section: Introductionmentioning

confidence: 99%

Direct autotransfusion following emergency pericardiocentesis in patients undergoing cardiac electrophysiology procedures

Barbhaiya

Guandalini

Jankelson

et al. 2020

Cardiovasc electrophysiol

View full text Add to dashboard Cite

Introduction: Acute hemopericardium during cardiac electrophysiology (EP) procedures may result in significant blood loss and is the most common cause of procedure-related death. Matched allogeneic blood is often not immediately available. The feasibility and safety of direct autotransfusion in cardiac electrophysiology patients requiring emergency pericardiocentesis is unknown.Methods: We retrospectively analyzed records of patients undergoing EP procedures at a single, tertiary care medical center who had procedure-related acute hemopericardium requiring emergency pericardiocentesis during a 3-year period.Procedure details, transfusion volumes, and clinical outcomes of patients who received direct autotransfusion of aspirated pericardial blood via a femoral venous sheath were compared to those of patients who did not receive direct autotransfusion.Results: During the study period, 10 patients received direct autotransfusion (group 1) and outcomes were compared with those of 14 control patients who did not receive direct autotransfusion (group 2). The volume of aspirated pericardial blood was similar in groups 1 and 2 (1.6 ± 0.7 L vs 1.3 ± 1.0 L, respectively; P = .52).Amongst patients with aspirated volumes <1 L, group 1 patients (n = 4) were less likely than group 2 patients (n = 8) to require allotransfusion (0% vs 75%, P = .02).Amongst patients with aspirated volume ≥1 L, group 1 patients (n = 6) required fewer units of red cell allotransfusion than group 2 patients (n = 6) (1.5 ± 0.8 units vs 4.3 ± 2.0 units, P = .01). No procedural complications related to direct autotransfusion occurred. Conclusions: Direct autotransfusion following emergency pericardiocentesis during electrophysiology procedures requiring systemic anticoagulation is feasible and safe.

show abstract

Autologous blood reinfusion during iatrogenic acute hemorrhagic cardiac tamponade: Safety and feasibility in a cohort of 30 patients

Cited by 18 publications

References 36 publications

Management of acute cardiac tamponade by direct autologous blood transfusion in interventional electrophysiology

Management of acute cardiac tamponade by direct autologous blood transfusion in interventional electrophysiology

Chronic total occlusion percutaneous coronary intervention complications: prevention and management

Direct autotransfusion following emergency pericardiocentesis in patients undergoing cardiac electrophysiology procedures

Contact Info

Product

Resources

About