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Home > Images > Thoracic Trauma > Total inflow occlusion manoeuvre of the heart

Lt Col Luis Manuel Garcia-Nunez MD Military Central Hospital, Mexico City.

Schumacker´s manouevre (total inflow occlusion manouevre) is performed by clamping superior vena cava at level of atrio-caval junction and inferior vena cava at level of Gibbon´s space, using straight vascular clamps, i.e. Crawford-DeBakey clamps. This picture shows the effective arrest of hemorrhage, allowing the trauma surgeon to repair the heart lacerations in a controlled setting. In this case, our team successfully repaired the atrial laceration which was secondary to gunshot injury to the thorax.

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satpal, May 21, 2010

I believe that manouvre is called Trendleberg and was originally proposed or used for Pulmonary Embolism.
I find the underlying concept and approach for these extremly challenging situations sound and logical.
Definitely an advance over direct pressure,Foley’balloon temponade etc.for the management of cardiac injuries.
However my concern is the logistics and timeframe to achieve this outside advanced Trauma care settings.

LuisManuel, May 22, 2010

Dear Dr:
Out of question, this manouvre is quite useful for the management of exsanguinating injuries of the atriocaval junction and the heart. On the other hand, I have not heard anything about the use of this manouvre in the setting of PE.
The correct name of the maneuver is Schumacker`s maneuver. I invite you to visit the corresponding chapter in the book of Dr Feliciano and Mattox (The heart).
Best regards
Central Military Hospital, Mexico City

Paul Vargas, May 29, 2015

This maneuver is very similar to the Sauerbrunch´s maneuver, with the difference that in the Sauerbrunch´s maneuver, the occlusion of the inflow it´s only partial holding the atrio-caval junction between the third and fourth fingers and stabilizing the heart with the rest of the fingers , but considering that the safe period for the Schumacker`s maneuver is only 1-3 minutes before a possible cardiac arrest is presented and even earlier in acidotic or ischemic patients, I think the Sauerbrunch´s maneuver although it doesn´t control the hemorrhage as good as the Schumacker`s maneuver it gives the surgeon the advantage of having more time to repair the wound before any possible complication its presented and also search for adjacent lesions as it is very common in gunshots injuries.

Military Medical School, Mexico City

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