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Emergent cardiopulmonary bypass in canines with penetrating cardiac wounds caused by gunshot
  1. Jinzhou Zhang1,
  2. Wen Wang2,
  3. Wensheng Chen1,
  4. Hailong Zhu1,
  5. Jincheng Liu1,
  6. Guocheng Sun1,
  7. Qin Cui1,
  8. Weiyong Liu1,
  9. Dinghua Yi1
  1. 1
    Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, People’s Republic of China
  2. 2
    Department of Traditional Chinese Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, People’s Republic of China
  1. Dr Yi Dinghua, Department of Cardiovascular Surgery, Xijing Hospital, the Fourth Military Medical University, Xi’an(710032), People’s Republic of China; jinzhouzhang2006{at}yahoo.com

Abstract

Background: Most patients with penetrating cardiac wounds die within minutes of injury from uncontrolled haemorrhage and acute cardiac dysfunction. Thus, sustaining sufficient circulation rapidly is crucial to saving lives. Emergent cardiopulmonary bypass (CPB) is a potential intervention to maintain circulation after penetrating cardiac wounds from a gunshot.

Methods: Canines were wounded with a bullet and randomly split into one of three treatment groups. Animals in group 1 (Gp1) were treated with conventional methods. Animals in group 2 (Gp2) received emergent CPB for 180 min and autologous blood transfusion. Animals in group 3 (Gp3) received emergent CPB for 30 min followed by surgical repair. Animal survival, haemodynamics and blood chemistry were measured, and lung water content was evaluated at the end of the experiment.

Results: The right ventricle was the most severely wounded cardiac chamber. In Gp1, mean arterial pressure and central venous pressure were dramatically decreased 8 min after injury, and all animals died within 18 min. In Gp2 and Gp3, mean arterial pressure ranged from 60–90 mm Hg during CPB. 60 min after terminating CPB in Gp2, mean arterial pressure and heart rate were decreased compared to Gp3. In Gp3, most animals maintained haemodynamic stability. 60 min after CPB, free haemoglobin in circulating blood was elevated compared to pre-trauma levels. Pulmonary water content was significantly higher in Gp2 and Gp3 than in Gp1.

Conclusions: Emergent CPB in the field can maintain haemodynamic stability and supply vital organs with sufficient blood flow, but surgery following CPB is essential to rescue patients with penetrating cardiac wounds.

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Footnotes

  • Competing interests: None declared

  • Abbreviations:
    CPB
    cardiopulmonary bypass
    PAWP
    pulmonary artery wedge pressure
    PCW
    penetrating cardiac wounds
    SOL
    signs of life

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