Rapid Admixture Blood Warming: Fast, Safe & Inexpensive

Kenneth V Iserson

Kenneth V Iserson Professor Emeritus, Emergency Medicine The University of Arizona, Tucson, USA

Abstract

Â Â Â Â Â Â Â The international standard for banked blood, including packed red blood cells (PRBCs), requires keeping it at 4ÂºC. Patients who need rapid PRBC unit transfusions benefit tremendously from blood being warmed to body temperature (37ÂºC), since hypothermia resulting from rapid infusion of cold blood is a major risk factor in exanguinating patients. It increases morbidity and mortality as well as often producing other adverse reactions, including those simulating transfusion reactions. Ideally, methods to warm blood for rapid transfusion should bring the unit to body temperature (37ÂºC), and be rapid, safe and inexpensive.Â Â Â Â Â Â Â Â Â Â Â In most centres, cliniciansâ€™ ability to adequately warm PRBC units suffers from the time constraints of needing to infuse blood quickly, the frequent need to infuse blood simultaneously through multiple IV lines, and the cost and availability of blood-warming equipment. There are three methods available for re-warming PRBC units: passive warming towards room temperature (inadequate), in-line warming (slow or extremely expensive), and pre-warming. Â Â Â Â Â Â Â Â Â Â Â This paper describes a safe, rapid and inexpensive method to pre-warm PRBC units. The only piece of capital equipment needed for this process is a standard 70ÂºC laboratory incubator in which to preheat 250 0.9 normal saline (NS) bags. Only one incubator, which generally lasts for decades, is needed for an emergency department, operating room, or intensive care unit; if they are in close proximity, only one is needed for all of them.Â Â Â Â Â Â Â Â Â Â Â Published studies and extensive clinical experience have shown that this method not only is safe and easy to use, but also preserves erythrocyte integrity and survival time. Rapid admixture blood warming is so inexpensive, simple, safe, and fast that it can and should be the primary method used for blood warming in most parts of the world.

Author Biography

Kenneth V Iserson, Professor Emeritus, Emergency Medicine The University of Arizona, Tucson, USA

Kenneth V. Iserson, M.D., MBA, FACEP, FAAEM, FIFEM, one of the worldâ€™s first residency trained emergency physicians, practiced and taught for nearly three decades at the emergency department/Level 1 Trauma Center at The University of Arizona. He is also the Medical Director (Emeritus) of the Southern Arizona Rescue Association (search & rescue), a Supervisory Physician with Arizonaâ€™s Disaster Medical Assistance Team (AZ-1), and a member of the American Red Cross disaster response team. The author of hundreds of scientific articles on emergency medicine and biomedical ethics, he has also authored numerous books, including Improvised Medicine: Professional Care in Extreme Environments (McGraw-Hill, 2012), Isersonâ€™s Getting Into a Residency: A Guide for Medical Students, 8th edition (Galen Press, 2013), and The Global Healthcare Volunteerâ€™s Handbook: What You Need to Know Before You Go (Galen Press, January 2014).Dr. Iserson now limits his medical practice to global and disaster medicine. In the past few years, he has practiced or taught on all seven continents, including 6 months as Lead Physician for the US Antarctic Program, and work with NGOs in rural areas of Central and South America, Asia, and Sub-Saharan Africa.

References

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