When the blood-back detection system fails: an IABP case report.

A 74-year-old male patient's circulation was supported by an intra-aortic balloon for a period of six days following multiple cardiac infarcts. On the sixth day, several 'leak in IAB circuit' alarms appeared. The nursing staff checked the tubing and refilled the balloon, as described in the manual, without notifying the medical staff or perfusionist. A few hours later, the balloon showed a leak, as blood was seen in the catheter tubing. This leak resulted in considerable damage to the device caused by a large amount of blood migrating back to the tubing and flooding the internal drive system, due to a failing 'blood detection' sensor. The balloon catheter was removed percutaneously and intra-aortic counterpulsation was discontinued. The patient died 20 days later of heart failure. This raises doubts over the adequacy of the protective sensors of such devices and, importantly, how to interpret the present user manuals and the instructions for troubleshooting.

Re-inventing the wheel; the use of autologous and fresh donor blood in cardiac surgery.

From the opening of a new cardiac surgical programme in November 1992, autologous and fresh donor blood (FDB) were used rather than cold stored blood (CSB) wherever possible in patients undergoing operations involving the use of cardiopulmonary bypass (CPB). In the first 250 consecutive patients, autologous blood was used in 168 (67.2%), fresh blood was used in 188 (75.2%). A total of 740 units of fresh blood were obtained on the day of operation (mean 3.9 +/- 1.6 units per patient able to supply donors; 4.9 +/- 1.7 units in the 147 who received fresh blood) and 728 units of stored blood were used (mean 3.08 +/- 1.84 units per patient where fresh blood was used; 6.2 +/- 2.5 units in the 114 where no fresh blood was used). The use of autologous blood significantly reduced FDB and CSB requirements (p < 0.001), was associated with a shorter intensive care and total postoperative stay (p = 0.006 and p = 0.033 respectively), even though there were more urgent and emergency cases in this group (p = 0.009) and no significant difference in chest drainage. Coagulopathy developed in 41 patients (16.4%) and was significantly associated with bypass time (p = 0.0001) and preoperative renal dysfunction (p = 0.005), although not with advanced age, sex, redo operation, diabetes or glucose-6-phosphate dehydrogenase deficiency. Patients with coagulopathy had significantly more transfused blood and blood products (p = 0.0001) and longer intensive care and total postoperative stays (p = 0.0001). In terms of blood conservation, the use of autologous blood was of primary importance.(ABSTRACT TRUNCATED AT 250 WORDS)