Draining the Patient

Bloodletting, almost as old as surgery itself, has lately been out of favor. But in the current American Journal of Surgery, two Cleveland doctors recommend a bloodletting technique so radical and daring that an oldtime chirurgeon would have paled at the thought of it. Their method: deliberately drain away the patient's blood, in amounts up to 2 1/2 or even 3 quarts, during certain serious types of surgery, then replace it as needed.

Dr. W. James Gardner and Dr. Donald E. Hale had been concerned with the surgeon's problems and the patient's danger in operations where profuse bleeding is likely (a common example: removal of brain tumors). During such an operation the patient may go into deep shock. At this point an intravenous transfusion is normally given, but it is not always successful. One reason for the occasional failures, say Drs. Gardner and Hale, is that the donor blood, received through the veins, puts an added load on an already weakened heart.

How much better it would be, they reasoned, to reduce the patient's blood volume (and hence, blood pressure) at the beginning, so that there would be little or no loss from uncontrollable bleeding at the site of operation. They opened an artery in the wrist and let the heart pump the blood out through a rubber tube into a collecting flask (containing heparin, to prevent clotting). By an ingenious arrangement of valves and flasks, the doctors could draw more blood at will, leave the supply stationary, or pump it back. With the systolic blood pressure down to about 80 mm., the surgeons could operate more confidently because they had the patient's blood supply under full control.

There are other advantages, said Drs. Gardner and Hale: the patient's own blood is better for him than that of any donor, and blood pumped back into the body toward the heart through an artery, instead of a vein, puts no extra burden on the heart. Their reservoir setup, they said, "may be likened to an accessory heart."

Where a surgeon must work in the skull, or perhaps the chest, their technique gives an added margin of safety, the surgeons report after using it in 50 operations (in which they drew off an average of 3 1/2 pints of blood). But, they warn, so drastic a procedure is not to be lightly used--and never used for an operation on a limb or in the abdomen, where bleeding is easily controlled. In fact, they say, it should only be used in "cases in which the surgeon encounters bleeding which would endanger life or function."

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