RAPID INFUSION SYSTEM FOR NEUROSURGICAL TREATMENT OF MASSIVE INTRAOPERATIVE HEMORRHAGE

Using an illustrative case of severe closed head injury that resulted in a posterior fossa epidural hematoma (EDH) and supratentorial epidur al/subdural hematomas (SDH), the massive blood losses associated with operative repair of the torn sigmoid sinus and the significant fluid l osses associated with refractory diabetes insipidus were treated by th e intraoperative use of the Rapid Infusion System (RIS, Haemonetics). The RIS can rapidly infuse warm blood, crystalloid, or colloid at rate s up to 1.5 L/min, thereby limiting the commonly associated hypotensio n, hypothermia, and coagulopathies. During the suboccipital craniectom y for evacuation of the EDH and repair of the sigmoid sinus, the patie nt required 18 units of blood replacement secondary to a large tear in the sigmoid sinus. During a separate craniotomy for evacuation of the SDH, the patient also developed diabetes insipidus, which increased t he operative fluid replacement to 39 L. Despite these massive blood an d fluid losses, the RIS limited the hypotension to less than 2 min and prevented hypothermia and the frequently associated coagulopathies. W hen used in a neurosurgical setting associated with massive blood and/ or fluid losses, the RIS accomplishes three important objectives: (1) rapid infusion of intravenous fluids for maintaining perfusion pressur e, (2) rapid warming of fluids despite high intravenous infusion rates of cold crystalloids, thereby preventing intraoperative hypothermia, and (3) continuous monitoring of infusion rates and totals.