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Acute gastrointestinal (GI) bleeding is a significant cause of death in U.S. adults and results in over 600,000 emergency department (ED) visits annually.¹ The morbidity rate in these cases ranges from 3% to as high as 11%, with fatalities primarily attributed to massive blood loss and ensuing hemorrhagic shock.^2,3

Elderly patients account for the majority of those presenting to the ED with upper GI hemorrhage.¹ However, risk factors such as alcohol abuse, tobacco abuse, cirrhosis, NSAID use, history of ulcers, and H. pylori infection also contribute to the likelihood of severe GI bleeding.^1,4

In cases of acute GI bleeding and concurrent hemorrhagic shock, the priority is rapid volume resuscitation to stabilize blood pressure and ensure perfusion. This often necessitates the activation of a mass transfusion protocol (MTP) to quickly deliver blood products. Conventional methods of volume resuscitation include IV pumps, pressure bags, and rapid infusers.

While rapid infusers are highly effective once operational, they can be cumbersome to set up, particularly in high-stress situations, leading to delays in care. Furthermore, many ED providers report being unfamiliar with their operation, which can increase the risk of errors and introduce significant care delays.^5,6

This case illustrates the effectiveness of LifeFlow PLUS, a handheld rapid infuser, in providing rapid volume resuscitation for a patient experiencing acute GI bleeding and severe hemorrhagic shock.

Case Presentation and Challenges

A 60-year-old male patient with alcohol use disorder and prior gastric ulcers presented to the ED with reported melena, raising concerns for an active upper GI bleed. On examination, the patient appeared critically ill, exhibiting pallor and hypotension.

The patient’s vital signs indicated profound shock, with a blood pressure of 50/30 despite being on three vasopressor drugs and a heart rate of 125. Due to the severity of his condition, the patient was intubated in the ED, and preparations were made for an emergency esophagogastroduodenoscopy (EGD) to control the suspected source of bleeding.

Management

Based on the patient’s presentation of severe hemorrhagic shock, MTP was promptly initiated. A central line was established via a cordis catheter, and packed red blood cells (PRBCs) were administered using the LifeFlow PLUS device. Throughout resuscitation, at least ten units of PRBCs and eight units of fresh frozen plasma (FFP) were all delivered using LifeFlow.

Following these interventions, the patient’s blood pressure stabilized, enabling him to undergo EGD, during which the gastric ulcer causing his bleeding was cauterized. The patient weaned off vasopressors the following day. He was extubated shortly thereafter and made a full recovery, walking out of the hospital without further complications.

Discussion

This case underscores the critical importance of efficiently delivering blood products for patients with hemorrhagic shock. Although a Belmont Rapid Infuser was present in the ED, the clinical team lacked familiarity with its setup and operation, which could have delayed care. By contrast, the providers said that LifeFlow was fast and easy to use, allowing them to deliver the needed blood products almost immediately. Providers emphasized LifeFlow’s user-friendly nature and the speed at which the device can infuse blood products, making it a valuable tool in emergent situations.

In today’s healthcare landscape, where high staff turnover and nursing shortages are prevalent, it is imperative that medical devices are both effective and easy to use. LifeFlow meets these needs, offering a highly portable, one-handed solution that providers can set up quickly and use confidently without the need for prior experience. When minutes matter, LifeFlow offers a path to faster blood products and fluid administration in emergent situations, improving outcomes for critically ill patients.