Continuous Postoperative Pericardial Flushing: A Pilot Study on Safety, Feasibility, and Effect on Blood Loss

• Main Authors: Johan S.J. Manshanden, Chantal L.I. Gielen, Corianne A.J.M. de Borgie, Robert J.M. Klautz, Bas A.J.M. de Mol, David R. Koolbergen
• Format: Article
• Language: English
• Published: Elsevier 2015-09-01
• Series: EBioMedicine
• Subjects: Continuous postoperative pericardial flushing; Therapeutic irrigation [mesh]; Pericardial cavity; Cardiac surgical procedures [mesh]; Thoracic surgery [mesh]; Postoperative hemorrhage [mesh]; Cardiac tamponade [mesh]; Chest tubes [mesh]
• Online Access: http://www.sciencedirect.com/science/article/pii/S2352396415300839

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.