Thromboemboli, acute right heart failure and disseminated intravascular coagulation after intraoperative application of a topical hemostatic matrix.
Topical hemostatic agents are frequently used in spine surgeries to control or reduce bleeding. Although there are a number of commercially available products, at our institution, an absorbable gelatin powder (Surgifoam) is mixed with bovine thrombin and used for this purpose. We report the case of a patient undergoing a posterior spinal fusion for scoliosis who developed acute right heart failure, cardiac arrest, and disseminated intravascular coagulation after probable intravascular hemostatic agent-induced emboli. Clinicians need to be aware of this potentially deadly complication associated with topical hemostatic agents.
Ferschl
Marla B
MB
Department of Anesthesia and Perioperative Care, University of California, San Francisco, California, USA.
Rollins
Mark D
MD
D000293:Adolescent; D000818:Animals; D002245:Carbon Dioxide / Q000097:blood; D002417:Cattle; D004211:Disseminated Intravascular Coagulation / Q000209:etiology*; D017548:Echocardiography, Transesophageal; D005260:Female; D005780:Gelatin / Q000009:adverse effects*; D006323:Heart Arrest / Q000209:etiology / Q000628:therapy; D006333:Heart Failure / Q000209:etiology*; D006400:Hematocrit; D006490:Hemostatics / Q000009:adverse effects*; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology*; D010976:Platelet Count; D012600:Scoliosis / Q000601:surgery; D013917:Thrombin / Q000009:adverse effects*; D013923:Thromboembolism / Q000209:etiology*; D014057:Tomography, X-Ray Computed
D006490:Hemostatics; D002245:Carbon Dioxide; D005780:Gelatin; D013917:Thrombin