To the Editor.—In Graham et al's article entitled, "Ruptured Abdominal Aortic Aneurysm" which appeared in the Archives (97:1024-1031 [Dec] 1968), I noticed that a great number of patients died on the operating table secondary to shock.
The article prescribed the insertion of only two intravenous cannulas for transfusion. However, in a ruptured aneurysm, the administration of blood through only two cannulas may be too slow. The average speed with which one can administer a blood transfusion through a 14-gauge cannula is one pint per five minutes. In cases of a ruptured great vessel, blood loss may exceed 1,000 cc every five minutes and may even be as high as 2,000 cc or more every five minutes. I once had to administer 13 pints in less than 20 minutes to keep the patient out of shock. This would have been rather difficult with only two cannulas, but could be