Pack and close approach to persistent postcardiopulmonary bypass bleeding.

Abstract

Persistent intraoperative hemorrhage after cardiopulmonary bypass was managed in three patients by packing the suspected bleeding sites with surgical sponges, leaving the packs in place and closing all layers of the sternal wound. The maneuver reduced the rate of bleeding to acceptable levels. The day after the primary operation the wounds were reopened and the surgical sponges were removed. Bleeding had ceased and the operative field remained dry in all three patients. Definitive closure of the sternotomy incisions was then performed. The method is proposed as a simpler alternative to the commonly used approach of leaving the mediastinum open for days and closing the wound after the bleeding stopped.