Factors that influence early extubation: bleeding

Excessive bleeding after cardiac surgery is an important factor that can prevent early extubation. Hemostatic derangement is well recognized to be associated with cardiopulmonary bypass, with many possible contributing factors resulting in coagulation defects and fibrinolytic pathway activation. Measures to optimize hemostasis are critical when managing patients for whom early extubation and hospital discharge are goals. The intraoperative evaluation of the hemostatic system with tests like the thrombelastogram and the use of therapeutic agents such as aprotinin are simple, safe, and effective methods of achieving these goals.