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

• This pilot study shows safety and feasibility of continuous postoperative pericardial flushing (CPPF) in experimental setting;
• CPPF improves chest tube patency and postoperative drainage;
• CPPF may reduce postoperative bleeding complications after cardiac surgery.Continuous postoperative pericardial flushing (CPPF) has specifically been designed to promote the evacuation of contaminated blood and clots out of the pericardial cavity in order to reduce postoperative blood loss and other bleeding complications. To our knowledge, there is no literature available on techniques similar to CPPF after cardiac surgery. Current state of the art techniques to reduce blood loss after cardiac surgery all have different targets and/or time of action. Regardless of their effects, the use of CPPF is an additional improvement to the current state of the art. We report that CPPF is safe and feasible in the experimental setting that was used and that CPPF may reduce postoperative blood loss and bleeding complications. The 30% reduction of blood loss that we found in this pilot study needs to be confirmed in a randomized clinical trial.

BackgroundProlonged 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.MethodsBetween 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).ResultsCPPF 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.ConclusionsCPPF 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.

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