[HSF] Reclacitrant sternal bleeding

[Tea Acuff]

To what do you attribute this very unusual senerio?
Tea


----- Original Message ----
From: prasannasimha <prasannasimha at gmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Tuesday, December 5, 2006 2:32:31 PM
Subject: Re: [HSF] Reclacitrant sternal bleeding


Lost the battle - this fortnight has been bad. Patient fibrillated as I 
was proceeding to the Hospital. CPR was pretty unsuccessful - basically 
was receiving lots of blood products etc at the time of fibrillation.
I had used the surgicel trick but it also hadn't worked. (Hence the 
surgicel gauze + gause roll and used the sternal spreader for 
compression.  I wish I had knocked off the sternum in the morning 
itself. I was thinking what if I had taken a large fold of pericardium 
and sutured it above and below the upper and lower tables to locally 
tamponade the bleeding area ? I always used to say that sternal bleeding 
is managed best by compressing the two ends together but  that just 
didn't work for him.
Prasanna

Ben Bidstrup wrote:
>> Urgent suggestions - pt underwent surgery yesterday - bleeding from 
>> sternum - doesn't seem to stop with wax + cautery + blood products - 
>> chest open packed - no cardiotomy site bleeding - continuing to bleed 
>> (This fortnight has ruined by blood conservation record :-) ) -
>> Now open packed with gauzes after layering with surgicel  and gauze 
>> and compressed it with the sternal spreader but still oozing - tried 
>> to close twice hoping that it may compresss the sternal edges and 
>> stop the bleeding but hasn't worked. Just bleeds from multiple sites 
>> along the sternal (both edges , marrow and small fractures). Thinking 
>> of doing a sternectomy if a further round of platelets Cryo and fresh 
>> blood doesn't work as I am getting low on blood resources. Any 
>> suggestions - I do not have access to Novo seven /TEGetc. patient had 
>> received Aprotinin through surgery and surgical sites are dry.
>> Plan is to do sternectomy soon if this round of products is not 
>> controlling the hemorrhage. Any tricks etc are appreciated. This has 
>> been a pretty "interesting"  fortnight for me.
>> Prasanna
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>
> I have use Surgicel in one of its forms folded longitudinally and 
> placed along the cut and bleeding edges. I then close the sternum 
> using this to compress/tamponade the bleeding. If you have a 
> centrifuge  like a cell saver, you can add platelet gel to it.
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