From: Steven Curry

Subject: DVT Prophylaxis in the Morgue

We have just completed a 4-phase research project that has major cost-saving implications. I feel obligated to share these results with the group. As most members know, Thromboguards, intermittent calf/calf-thigh compression devices, used in bed-ridden patients, decrease the incidence of DVT and PE. Interestingly, previous studies showed that applying the devices to arms works just as well as applying them to legs. Presumeably this is because arm compression still results in fluctuations in venouspressure gradients that help move blood from the legs and pelvis.

In the first phase of our project, we confirmed that applying Thromboguards to one arm worked as well as applying them to both arms or both legs. And, indeed, we found this to be true. The second phase of our project involved patients undergoing amputations of legs and arms for ischemic events, necrotizing fascitiis, and cancer. To our surprise, we found that placing the Thromboguard on the amputated arm or leg still protected the patient! That is, after the leg or arm was amputated, if the arm or leg was left in the patient's room and conntected to a Thromboguard unit, patients still were protected from DVT formation.

We next wondered the degree of distance limitations between the patient and the amputated extremity. In phase three we found that as a Thromboguard was placed on a single amputated arm or leg in the entire ICU that everyone in the ICU was protected from DVT! We have just completed the final phase and have confirmed that a single amputated arm or leg attached to a Thromboguard unit in the morgue protects the entire hospital! We calculate cost savings in the hundreds of thousands of dollars each year by keeping an arm or leg in the morgue under intermittent compression. Prophylactic heparin use has disappeared, but the study results raise major additional questions that must be investigated:

1. If a single person in the ICU (or the hospital)is anticoagulated with heparin or coumadin, will all the patients by anticoagulated? This may place head injuries, GI bleeders, and others at undue risk.

2. Could the Thromboguard unit in the morgue protect more than one hospital, or perhaps, an entire city?

3. Could a Thromboguard unit on the moon protect the entire earth?

4. Would the placement of a Greenfield filter in a cadaver in the morgue protect the entire hospital?

I would be most interested to hear of others' experiences, including those from Australia where blood flows backwards through the venous system.

Steven Curry, M.D.,Department of Medical Toxicology, Good Samaritan Regional Medical Center, Phoenix, AZ USA.