Normothermic rapid volume replacement for hypovolemic shock: an in vivo and in vitro study utilizing a new technique

Hypovolemic shock secondary to intraoperative or traumatic hemorrhage requires urgent, aggressive resuscitation to achieve a successful outcome. Common difficulties encountered include the need for venous access, restoration of blood volume, and most important, maintenance of normothermia. The rapid solution administration set utilized in this study addresses the above limitations. Venous access is quickly accomplished by the percutaneous insertion of a large-bore catheter into the central venous system. The set requires only one central venous entry site for adequate fluid resuscitation. Expeditious restoration of blood volume is accomplished by gravity-induced infusion of crystalloids, colloids, and blood products at flow rates of up to 1,600 ml/minute. High flow rates are obtained by utilizing low-resistance filters and large-bore perfusion tubing. Avoidance of transfusion-induced hypothermia is addressed by incorporation of an extracorporeal heat exchanger into the administration set. The infusate temperature is maintained at 37 degrees C regardless of the administration rate or the initial fluid temperature. In vitro and canine in vivo testing demonstrated no significant hemolysis of the transfused blood and allowed maintenance of normothermia.