Pressure Transfusion of Blood

Abstract

DURING the past decade the popularity of perarterial blood transfusion in the treatment of severe hzmorrhage or traumatic shock has increased considerably. Binghaml et alia report their clinical impressions and observations in support of their belief that perarterial transfusion will succeed where intravenous transfusions will fail in resuscitaticn of patients cearly or apparently dead from circulatory collapse due to shock or hzmorrhage.It is suggested that the reason for rapid improvement in moribund patients is due to the improvement in the coronary arterial blood supply to the heart, quite apart from the increase in the circulatory blood volume.On the other hand, intravenous transfusion, it is thought, acts by increasing the volume of venous return to the heart and thereby increasing the cardiac output. Arterial pressure in the effective part of the circulation must then rise.Kohlstaedt and Page3 produced circulatory collapse in a series of dogs by bleeding. The animals were subjected to known periods of severe hypotension and then treated by venous or arterial transfusions of blood. Their results showed that arterial retransfusions of 50% of blood removed, at an initial pressure of 50 mm. of mercury, produced recovery in 75% of animals, whereas similar retransfusion of the same proportion of blood by vein at a pressure gauged to avoid increase in intrathoracic venous pressure above 5 cm. of water, produced recovery in only 30y0 of animals.There are, however, disadvantages in arterial transfusion in practice. Venoclysis demands no great surgical skill, but arterial puncture which is most frequently of the radial artery usually entails skin incision and exposure of the artery. Although it is recommended that the vessel should be repaired by suturing, it is likely that its permanent occlusion results in most cases. Instances of digital ischzmia' are not infrequent, though quoted as a small price to pay for better prospect of successful resuscitation. Yee et a16 report a case of gangrene of forearm and hand following transfusion by the radial artery.It is the experience of many surgeons that rapid intravenous 166

"Epidemic Collapse"

“…The two most useful points to teach would seem to be: (1) stopping severe external bleeding by direct pressure over the wound1; (2) artificial respiration, by mouth-to-mouth method. Since 1962 about 700 people have attended a two-hour course here, which was confined to these points, and was suitably illustrated with film, as well as a demonstration of artificial respiration on a model.…”