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Pack and close approach to persistent postcardiopulmonary bypass bleeding
R L Berger1, R F Dunton, H K Leonardi
1Overholt Division of Cardiothoracic Surgery, New England Deaconess Hospital, Boston, Massachusetts.
Insights
Persistent intraoperative hemorrhage after cardiopulmonary bypass can be managed by temporary sternal wound packing with surgical sponges. This simpler method effectively controls bleeding, allowing for delayed wound closure and avoiding prolonged mediastinal drainage.
Area of Science:
- Cardiovascular Surgery
- Surgical Hemorrhage Management
- Thoracic Wound Care
Background:
- Persistent intraoperative hemorrhage following cardiopulmonary bypass presents a significant clinical challenge.
- Current management often involves leaving the mediastinum open for extended periods, increasing infection risk and prolonging hospital stays.
Observation:
- A novel technique was employed in three patients experiencing persistent intraoperative bleeding after cardiopulmonary bypass.
- Suspected bleeding sites were packed with surgical sponges, and the sternal wound was completely closed.
Findings:
- This packing maneuver effectively reduced bleeding rates to acceptable levels during the initial surgery.
- Upon reopening the wounds the following day, bleeding had ceased, and the operative field was dry in all patients.
- Definitive sternotomy incision closure was then performed successfully.
Implications:
- This temporizing surgical sponge packing offers a simpler and potentially safer alternative to traditional open mediastinal management.
- The technique may reduce the risk of mediastinitis and shorten recovery times for patients with postoperative bleeding.
- Further studies are warranted to validate this approach in a larger patient cohort.
Abstract:
Persistent intraoperative hemorrhage after cardiopulmonary bypass was managed in three patients by packing the suspected bleeding sites with surgical sponges, leaving the packs in place and closing all layers of the sternal wound. The maneuver reduced the rate of bleeding to acceptable levels. The day after the primary operation the wounds were reopened and the surgical sponges were removed. Bleeding had ceased and the operative field remained dry in all three patients. Definitive closure of the sternotomy incisions was then performed. The method is proposed as a simpler alternative to the commonly used approach of leaving the mediastinum open for days and closing the wound after the bleeding stopped.