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A Chronic Cardiac Ischemia Model in Swine Using an Ameroid Constrictor

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Packing the chest: a useful technique for intractable bleeding after open heart operation

N Bouboulis¹, L F Rivas, J Kuo

¹Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom.

The Annals of Thoracic Surgery

|April 1, 1994

Summary

Temporary chest packing effectively controls intractable mediastinal bleeding after open heart surgery, achieving a 94% success rate. While complications like sternal wound infection occurred, this method offers a reasonable patient salvage rate.

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Area of Science:

Cardiovascular Surgery
Thoracic Surgery
Surgical Critical Care

Background:

Mediastinal bleeding is a significant complication following cardiac surgery.
Causes include coagulation issues and technical surgical problems.
Intractable bleeding necessitates advanced management strategies.

Purpose of the Study:

To evaluate the efficacy and safety of temporary chest packing for managing intractable mediastinal bleeding post-cardiac surgery.
To identify bleeding sites and patient risk factors.
To assess the impact of packing location and closure methods on outcomes.

Main Methods:

Retrospective analysis of 100 patients undergoing open heart operations over 10 years who received temporary chest packing for bleeding.
Data collected on predisposing factors, bleeding sites, packing procedures, closure techniques, and outcomes.
Comparison of outcomes based on packing venue and closure method.

Main Results:

94% of patients (94/100) had bleeding controlled with chest packing (65% single packing, 29% multiple packings).
Predominant bleeding sites included suture lines and general ooze.
24% of patients developed complications, including sternal wound infection, sepsis, and dehiscence, with an 8% mortality rate.

Conclusions:

Temporary chest packing is an effective method for controlling intractable mediastinal bleeding after cardiac surgery, yielding a high salvage rate.
The location of packing (OR vs. ICU) did not influence infection rates.
While complications exist, chest packing offers a viable option for managing severe post-cardiac surgery hemorrhage.