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Related Experiment Videos

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.

Journal of the American College of Surgeons
|April 1, 1994
PubMed
Summary

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.

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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.

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  • 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.