Continuous Postoperative Pericardial Flushing: A Pilot Study on Safety, Feasibility, and Effect on Blood Loss.
BACKGROUND
Prolonged or excessive blood loss is a common complication after cardiac surgery. Blood remnants and clots, remaining in the pericardial space in spite of chest tube drainage, induce high fibrinolytic activity that may contribute to bleeding complications. Continuous postoperative pericardial flushing (CPPF) with an irrigation solution may reduce blood loss by preventing the accumulation of clots. In this pilot study, the safety and feasibility of CPPF were evaluated and the effect on blood loss and other related complications was investigated.


METHODS
Between November 2011 and April 2012 twenty-one adult patients undergoing surgery for congenital heart disease (CHD) received CPPF from sternal closure up to 12 h postoperative. With an inflow Redivac drain that was inserted through one of the chest tube incision holes, an irrigation solution (NaCl 0.9% at 38 °C) was delivered to the pericardial cavity using a volume controlled flushing system. Safety aspects, feasibility issues and complications were registered. The mean actual blood loss in the CPPF group was compared to the mean of a retrospective group (n = 126).


RESULTS
CPPF was successfully completed in 20 (95.2%) patients, and no method related complications were observed. Feasibility was good in this experimental setting. Patients receiving CPPF showed a 30% (P = 0.038) decrease in mean actual blood loss 12 h postoperatively.


CONCLUSIONS
CPPF after cardiac surgery was found to be safe and feasible in this experimental setting. The clinically relevant effect on blood loss needs to be confirmed in a randomized clinical trial.
Department of Cardiothoracic Surgery, Academic Medical Center (AMC), Amsterdam, The Netherlands.
Johan S J
JS
Manshanden
Department of Cardiothoracic Surgery, Leiden University Medical Center (LUMC), Leiden, The Netherlands.
Chantal L I
CL
Gielen
Clinical Research Unit, University of Amsterdam, Amsterdam, The Netherlands.
Corianne A J M
CA
de Borgie
Department of Cardiothoracic Surgery, Leiden University Medical Center (LUMC), Leiden, The Netherlands.
Robert J M
RJ
Klautz
Department of Cardiothoracic Surgery, Academic Medical Center (AMC), Amsterdam, The Netherlands.
Bas A J M
BA
de Mol
Department of Cardiothoracic Surgery, Academic Medical Center (AMC), Amsterdam, The Netherlands ; Department of Cardiothoracic Surgery, Leiden University Medical Center (LUMC), Leiden, The Netherlands.
David R
DR
Koolbergen
D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D003710:Demography; D023381:Endpoint Determination; D017707:Erythrocyte Transfusion; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D010496:Pericardium / Q000473:pathology*; D010865:Pilot Projects; D011182:Postoperative Care; D019106:Postoperative Hemorrhage / Q000209:etiology*; D011300:Preoperative Care
Cardiac surgical procedures [mesh]; Cardiac tamponade [mesh]; Chest tubes [mesh]; Continuous postoperative pericardial flushing; Pericardial cavity; Postoperative hemorrhage [mesh]; Therapeutic irrigation [mesh]; Thoracic surgery [mesh]