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

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.