Intraarterial and intraaortic blood transfusion

Indications and mechanism of therapeutic action

In surgical and resuscitation practice, intraarterial transfusion is considered an emergency measure in critical scenarios. Key indications for the procedure include clinical death accompanied by complete cessation of respiration and cardiac activity against the background of uncompensated massive blood loss, as well as severe traumatic shock. In shock states, the reason for invasive intervention is a prolonged drop in systolic blood pressure (SBP) to a critical mark of 60 mm Hg. In addition, the method is indicated when standard intravenous transfusions prove ineffective.

The main therapeutic effect consists of powerful reflex stimulation of the patient's entire cardiovascular system. Rapid delivery of blood under pressure directly into the arterial bed allows for the prompt restoration of adequate blood flow through the coronary vessels, which is a vital condition for resuming myocardial pump function.

Procedure technique and pressure monitoring

The intraarterial transfusion procedure requires medical personnel to strictly observe pressure and rate parameters. The manipulation algorithm includes several sequential stages:

1. Pumping: Blood is injected into the arterial bed under a strict starting pressure of 200 mm Hg.
2. Rate regime: The recommended emergency transfusion rate is 200 to 250 ml over a very short period — from 1.5 to 2 minutes.
3. Pressure reduction: As soon as doctors manage to restore spontaneous cardiac activity, the pressure in the main system is immediately reduced to 120 mm Hg.
4. Change of vascular access: When the victim develops a distinct pulse on peripheral arteries, arterial pumping is stopped and they smoothly transition to traditional intravenous infusion.
5. Procedure completion: The arterial needle is finally removed from the vessel only after the patient's systolic pressure reliably stabilizes at safe values of 90–100 mm Hg.

Equipment and surgical accesses

The arterial transfusion system visually resembles a standard medical intravenous drip, but has a number of important design differences that allow for safe air pumping. A long needle is inserted into the bottle with the hemotransfusion medium, to which a Richardson bulb is connected — this serves as a manual device for pumping air. For continuous visual pressure monitoring, a pressure gauge is mounted into the circuit via a special tee.

Local infiltration anesthesia is used to gain access to the arterial bed. In surgery, there are two main approaches to vessels:

• Percutaneous puncture: Performed with a special Dufour needle. The most convenient for puncture are the femoral artery (a. femoralis) or brachial artery (a. brachialis).
• Arteriotomy (surgical isolation of the vessel): Performed primarily on the radial artery (a. radialis) or posterior tibial artery (a. tibialis posterior).

Important: Due to the delivery of the transfusion medium under pressure, the procedure is associated with an extremely high risk of developing air embolism. To prevent this formidable complication, medical personnel are obliged to continuously monitor the blood level in the system and timely clamp the line before the bottle completely empties.

Features of intraaortic transfusion

The intraaortic route of administration has specific indications. These include sudden clinical death and situations of massive, uncontrollable bleeding occurring directly during extensive thoracic surgeries.

The execution technique is based on the use of specialized catheters. They are passed retrogradely (i.e., against the natural blood flow) through peripheral arteries directly into the aortic lumen. The most frequent surgical access site for inserting such a catheter is the femoral artery; much less often, access is gained through upper extremity vessels — the brachial artery. The installation of the intraaortic catheter itself can be performed both by percutaneous puncture and by open vessel dissection. The blood pumping regime, including all pressure parameters, is completely identical to the strict rules of intraarterial transfusion.

Briefly: answers to topical questions

Class and exam questions

What else to study on this topic

• Technique of arteriotomy of the radial and posterior tibial arteries.
• Device, design features, and operating principle of the Dufour needle.
• Detailed algorithm of medical personnel actions in the threat of air embolism.
• Features of retrograde catheter insertion in intraaortic transfusion.

Other topics in the section "CHAPTER 6. BLOOD TRANSFUSION"

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