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Acute right ventricular failure and pulseless electrical activity arrest following auto-transfusion of blood.

ABSTRACT: Air embolism is a rare but potentially catastrophic complication of interventional procedures. The occurrence of acute right ventricular dysfunction during intraoperative auto-transfusion of blood, presumably related to pulmonary embolism of agitated air microbubbles and microthrombi, is less commonly recognized. We report a case of auto-transfusion complicated by acute right ventricular failure and pulseless electrical activity arrest. Auto-transfusion of recovered blood is a practical solution to reduce need for post-procedure allogenic transfusions. Although such interventions are frequently performed without complications, they do have inherent risks that should be readily acknowledged. This case clearly describes a severe complication and sequelae of auto-transfusion. <Learning objective: Auto-transfusion of recovered blood is commonly performed in surgical and interventional procedures to reduce the need for allogenic transfusion. Despite this benefit, the risks and complications of auto-transfusion can be severe and must be considered. We report a case of intraprocedural auto-transfusion resulting in introduction of air emboli and subsequent cardiac arrest. Additionally, we provide a brief review of air emboli and underlying pathophysiology that leads to cardiovascular decline.>.

SUBMITTER: Agboola KM

PROVIDER: S-EPMC6149568 | biostudies-literature | 2018 Apr

REPOSITORIES: biostudies-literature

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Acute right ventricular failure and pulseless electrical activity arrest following auto-transfusion of blood.

Agboola Kolade M KM Lasala John M JM Sintek Marc A MA Noheria Amit A

Journal of cardiology cases 20180112 4

Air embolism is a rare but potentially catastrophic complication of interventional procedures. The occurrence of acute right ventricular dysfunction during intraoperative auto-transfusion of blood, presumably related to pulmonary embolism of agitated air microbubbles and microthrombi, is less commonly recognized. We report a case of auto-transfusion complicated by acute right ventricular failure and pulseless electrical activity arrest. Auto-transfusion of recovered blood is a practical solution ...[more]

PMID: 30279871

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Project description:This study investigates the use of a Bayesian statistical model to address the limited predictive capacity of existing risk scores derived from multivariate analyses. This is based on the hypothesis that it is necessary to consider the interrelationships and conditional probabilities among independent variables to achieve sufficient statistical accuracy.Right ventricular failure (RVF) continues to be a major adverse event following left ventricular assist device (LVAD) implantation.Data used for this study were derived from 10,909 adult patients from the Inter-Agency Registry for Mechanically Assisted Circulatory Support (INTERMACS) who had a primary LVAD implanted between December 2006 and March 2014. An initial set of 176 pre-implantation variables were considered. RVF post-implant was categorized as acute (<48 h), early (48 h to 14 daysays), and late (>14 days) in onset. For each of these endpoints, a separate tree-augmented naïve Bayes model was constructed using the most predictive variables employing an open source Bayesian inference engine.The acute RVF model consisted of 33 variables including systolic pulmonary artery pressure (PAP), white blood cell count, left ventricular ejection fraction, cardiac index, sodium levels, and lymphocyte percentage. The early RVF model consisted of 34 variables, including systolic PAP, pre-albumin, lactate dehydrogenase level, INTERMACS profile, right ventricular ejection fraction, pro-B-type natriuretic peptide, age, heart rate, tricuspid regurgitation, and body mass index. The late RVF model included 33 variables and was predicted mostly by peripheral vascular resistance, model for end-stage liver disease score, albumin level, lymphocyte percentage, and mean and diastolic PAP. The accuracy of all Bayesian models was between 91% and 97%, with an area under the receiver operator characteristics curve between 0.83 and 0.90, sensitivity of 90%, and specificity between 98% and 99%, significantly outperforming previously published risk scores.A Bayesian prognostic model of RVF based on the large, multicenter INTERMACS registry provided highly accurate predictions of acute, early, and late RVF on the basis of pre-operative variables. These models may facilitate clinical decision making while screening candidates for LVAD therapy.

Dataset Information

Acute right ventricular failure and pulseless electrical activity arrest following auto-transfusion of blood.

Publications

Acute right ventricular failure and pulseless electrical activity arrest following auto-transfusion of blood.

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