Mediastinal packing for refractory nonsurgical bleeding after open-heart surgery

Patients with infective endocarditis and disseminated intravascular coagulation may require emergency valve replacement because of acute hemodynamic decompensation. After cardiopulmonary bypass is discontinued, nonsurgical hemorrhage, refractory to conventional treatment, may occur. The author describes a technique of mediastinal packing for temporary control of bleeding until the coagulation disorder can be corrected. The pack can be removed transcutaneously without reoperation. This method should be used only when all other approaches have failed to achieve hemostasis.