Total Chest Drainage Research Articles

Ultra-fast-track cardiac anesthesia in minimally invasive cardiac surgery: a retrospective observational study.

There is no uniformity on the safety profile of ultra-fast-track cardiac anesthesia (UFTCA), and there is a lack of research on the postoperative lung function status of patients with UFTCA. This retrospective study was to examine the benefits of UFTCA on the postoperative recovery and pulmonary function of patients undergoing minimally invasive cardiac surgery (MICS). This retrospective study was performed on patients who underwent MICS at Zhejiang Provincial People's Hospital between January 2022 and July 2023. Patients were retrospectively segregated into two groups: UFTCA group and conventional general anesthesia (CGA group). Primary endpoints encompassed differences in the duration of postoperative intensive care unit (ICU) stay and overall hospital stay. Secondary observations included in-hospital mortality rate, 3-month post-discharge survival rate, oxygenation indexes of preoperative (T0), immediately after extubation (T1), 6 hours after extubation (T2), and 12 hours after extubation (T3), use of high-flow nasal cannula oxygen therapy in the ICU, postoperative total chest drainage volume, and the rate of complications. Group comparisons were performed using grouped t-tests and repeated measures analysis of variance (ANOVA). The UFTCA group (n=327) demonstrated shorter ICU and hospital stays when compared with the CGA group (n=216) (P=0.001). At the immediately after extubation, the UFTCA group exhibited a decrease in oxygenation index [arterial oxygen partial pressure (PaO2)/fraction of inspired oxygen (FiO2)] accompanied by elevated alveolar-arterial oxygen tension difference [P(A-a)O2] and respiratory index [P(A-a)O2/PaO2] values compared to the CGA group (P=0.001). However, by 12 hours after extubation, the UFTCA group manifested an improved PaO2/FiO2 and diminished P(A-a)O2/PaO2 values compared to the CGA group. The UFTCA group required high-flow oxygen therapy after extubation with greater frequency than the CGA group (P=0.001). However, neither the UFTCA nor CGA group had patients who needed reintubation (P>0.05). No significant differences were observed in postoperative atelectasis and pulmonary edema rates between the groups (P>0.05), the UFTCA group recorded a diminished total chest drainage volume postoperatively (P=0.001). Incidence of postoperative nausea and vomiting (PONV) was heightened in the UFTCA group (P=0.01), while the incidence of delirium was less frequent when compared with the CGA group (P=0.001). UFTCA demonstrates potential benefits in minimizing ICU and postoperative hospital stay in patients undergoing MICS. This approach also contributes to a reduction in postoperative chest drainage volume and a decreased likelihood of postoperative delirium. Despite the initial decline in lung oxygenation immediately following early post-extubation, subsequent lung function proves to be superior, with no differences in postoperative atelectasis or pulmonary edema rates. However, the implementation of UFTCA requires additional strategies to prevent the occurrence of PONV.

The effects of tranexamic acid in patients treated with extracorporeal membrane oxygenation after cardiac surgery.

The lysine analog tranexamic acid (TXA) is used as a blood protective drug in cardiac surgery, but efficacy and safety outcomes in patients treated with extracorporeal membrane oxygenation (ECMO) after surgery remain poorly understood. From January 1, 2017 to December 31, 2022, we retrospectively analyzed patients assisted by ECMO after cardiac surgery and divided them into TXA and control groups depending on whether TXA was used or not. The primary study outcome was red blood cell (RBC) transfusion during ECMO. In total, 321 patients treated with ECMO after cardiac surgery were assessed; 185 patients were eligible for inclusion into to the TXA-intervention group and 136 into to the control group. RBC transfusion during ECMO was 8.0 IU (4.0 IU-14.0 IU) in the TXA group versus 10.0 IU (6.0 IU-16.0IU) in the control group (p = .034). Median total chest drainage volume after surgery was 1460.0mL (650.0-2910.0mL) and 1680.0mL (900.0-3340.0mL) in TXA and control groups, respectively (p = .021). Postoperative serum D-dimer levels were significantly lower in the TXA group when compared with the control group; 1.125µg/mL (0.515-2.176µg/mL) versus 3.000µg/mL (1.269-5.862µg/mL), p < .001. Serious adverse events, including vascular occlusive events, did not differ meaningfully between groups. In patients treated with ECMO after cardiac surgery, TXA infusion modestly but significantly reduced RBC transfusions and chest tube output when compared with the control group.

Preservation of the pulmonary branches of the vagus nerve during three-dimensional thoracoscopic radical resection of lung cancer: a retrospective study

BackgroundIn this study, we investigated the effect of preservation of the pulmonary branches of the vagus nerve during systematic dissection of mediastinal lymph nodes, when performing radical resection of lung cancer, on the postoperative complication rate.MethodsThe clinical data for 80 patients who underwent three-dimensional thoracoscopic radical resection of lung cancer in the Department of Thoracic Surgery at Huizhou Municipal Central Hospital between 2020 and 2022 were analyzed. The patients were divided into two groups according to whether the pulmonary branches of the vagus nerve were retained during intraoperative carinal lymph node dissection. The operation time, time until first postoperative defecation, duration for which a chest tube was needed, total chest drainage volume, average pain intensity during the first 5 postoperative days, incidence of postoperative pneumonia, and postoperative length of stay were compared between the two groups.ResultsThere was no statistically significant difference in histological staging or in time until first postoperative defecation between the two groups (p > 0.05). However, there were significant differences in operation time, the duration for which a chest tube was needed, total chest drainage volume, average pain intensity during the first 5 postoperative days, white blood cell count and procalcitonin level on postoperative days 1 and 5, and postoperative length of stay between the two groups (p < 0.05).ConclusionPreserving the pulmonary branches of the vagus nerve during carinal lymph node dissection when performing three-dimensional thoracoscopic radical resection of lung cancer can reduce the risk of postoperative complications.

Dancing swan in left hemithorax

A 67-yrs-old, diabatic,hypertensive individual was admitted for multivessel coronary artery bypass graft surgery . Off-Pump CABG was performed using Left Internal Thoracic Artery to Left Anterior Descending Artery, left radial artery to first Obtuse Marginal branch, and reversed saphenous vein graft to Posterior Descending Artery as conduits. His total chest drainage was 430 ml. His was discharged on 8th postoperative day. He was brought to emergency treatment unit on 28th postoperative day with cough and dyspoea.On examination he was dyspnoic, oxygen saturation was 88% on room air. Point of care Transthoracic Echocardiogram demonstrated “dancing swan in left hemi thorax” . (VIDEO). The TTE which included lung ultrasonography, showed left sided heterogeneously anechoic effusion with partial thin septation &amp; floating echoes. The partially collapsed left lower lobe dances during each cardiac pulsation due to propagation of a waveform across this moderate effusion. Exudate effusions often demonstrate punctate, hyper echoic foci floating within the effusion, referred to as Plankton sign. Intercostal drain was inserted on left side and 1.8 liters of hemorrhagic fluid was drained, total chest drainage was 2.4 liters.

Outcomes from adult veno-arterial extracorporeal membrane oxygenation in a cardiovascular disease center from 2009 to 2019.

Extracorporeal membrane oxygenation (ECMO) is an imperative short-term cardiopulmonary support device now. We aimed to provide a single-center experience of veno-arterial (V-A) ECMO management and identify the risk factors of in-hospital mortality. We conducted a retrospective review of adult patients who received V-A ECMO between 2009 and 2019 in a cardiovascular disease center. The risk factor analysis of in-hospital mortality was conducted. The study reviewed 236 patients, with an overall survival rate of 68.2%. The survivors' blood lactate concentration is significantly lower than non-survivors [7.4 (7.8) vs 11.1 (9.7), p = 0.002]. Patients who received heart transplantation were with higher in-hospital survival rate. Survivors developed less hepatic dysfunction, acute kidney injury and myocardial damage [23 (14.3%) vs 19 (25.3%), p = 0.039; 81 (50.3%) vs 51 (68%), p = 0.011; 24 (14.9%) vs 22 (29.3%), p = 0.009, respectively], with higher rate of continuous renal replacement therapy (CRRT) [56 (34.8%) vs 53 (70.7%), p < 0.001]. Fewer survivors' 24 hours and total chest drainage was over 1000 mL, and the rate of re-exploration as well as red blood cell and platelet transfusion were lower in survivors. In multivariate analysis, female, pre-ECMO blood lactate concentration, hyperlipidemia, CRRT, and 24 hours chest drainage ⩾ 1000 mL were risk factors of early mortality. By providing a general description of V-A ECMO practice at a single-center in China. Post-heart transplant graft failure was associated with numerically, the greatest survival in our practice. Furthermore, female sex, pre-ECMO blood lactate concentration, hyperlipidemia, CRRT, and high blood loss in chest drains are predictors of mortality in patients who undergo V-A ECMO.

Postoperative Short-term Outcomes Between Sublobar Resection and Lobectomy in Patients with Lung Adenocarcinoma.

BackgroundTo investigate postoperative temporary consequences of the enrolled patients with lung adenocarcinoma.Patients and MethodsWe analyzed the clinical data of patients with lung adenocarcinoma admitted by the same surgical team of Peking Union Medical College Hospital (PUMCH) from July 2019 to December 2019. Statistical methods including propensity score matching (PSM) analysis was used to analyze the differences among them.ResultsA total of 108 patients were enrolled, including 50 patients with sublobar resection and 58 patients with lobectomy. Before PSM, there were statistically significant differences in age (p=0.015), hospitalization costs (p=0.042), lymphadenectomy (p=0.000), pathological staging (p=0.000), number of lymph nodes removed (p=0.000), number of positive lymph nodes (p=0.034), chest drainage duration (p=0.000), total chest drainage (p=0.000), length of postoperative hospital stays (p=0.000), postoperative D-dimer level (p=0.030) and perioperative lymphocyte margin (LM) (p=0.003) between sublobar resection and lobectomy. After PSM, there were statistical differences in number of lymph nodes removed (p=0.000), chest drainage duration (p=0.031) and total chest drainage (p=0.002) between sublobar resection and lobectomy. Whether with PSM analysis or not, there were no significant differences in other blood test results, such as inflammation indicators, postoperative neutrophil-lymphocyte ratio (NLR), albumin level, perioperative activity of daily living (ADL) scale scoring margin, complications, postoperative admission to intensive care unit (ICU) and readmission within 30 days. NLR was associated with total chest drainage (p=0.000), length of postoperative hospital stays (p=0.000), postoperative D-dimer level (p=0.050) and ADL scale scoring margin (p=0.003) between sublobar resection and lobectomy.ConclusionSublobar resection, including wedge resection and segmentectomy, was as safe and feasible as lobectomy in our study, and they shared similar short-term outcomes. Postoperative NLR could be used to detect the clinical outcomes of patients. Secondary resectability of pulmonary function (SRPF) should be the main purpose of sublobar resection.

Balanced Chest Drainage Prevents Post-Pneumonectomy Pulmonary Oedema

Pneumonectomy in the adult patient is associated with a mortality of 1-9%. Death is often due to post pneumonectomy pulmonary oedema (PPPO). The use of balanced chest drainage system (BCD) in the setting of post pneumonectomy has been reported to be of benefit in the prevention of PPPO. This study seeks to compare the incidence of PPPO in patients who underwent pneumonectomy and whose empty pleural space was managed either with CRD or BCD. This retrospective observational cohort study involved 98 patients who were operated on by one surgeon at Liverpool Hospital, Sydney, Australia from 1997 to 2019. The patients were divided into two groups according to the era in which they had their pneumonectomy. Group 1 consisted of 18 patients managed with clamp-release drainage between 1997 and 2002. Group 2 consisted of 80 patients managed with balanced chest drainage between 2003 and 2019. The primary outcomes of interest were the development of PPPO and death. Demographic and clinico-pathological variables between the groups were compared including whether the phrenic nerve was sacrificed, volume of infused intraoperative fluid, duration of single lung ventilation, intraoperative tidal volumes, agents of anaesthetic induction and maintenance, mean urine output in the first 4 postoperative hours, institution of a postoperative 1.5 L fluid restriction, total chest drainage, day of chest drain removal, presence of radiological postoperative mediastinal shift, post-pneumonectomy pulmonary oedema and death. Group characteristics were compared using t-test and chi-squared for continuous and categorical variables respectively. Univariate and multivariate analysis was also undertaken using the Firth method of logistic regression for rare occurrences in a stepwise fashion. Through univariate analysis, balanced chest drainage, postoperative fluid restriction and intraoperative fluid infusion showed significant effect on PPPO. Through multivariate analysis, balanced chest drainage was found to have independent protective value for PPPO and mortality. Compared with clamp-release drainage, balanced chest drainage results in a lower incidence of post-pneumonectomy pulmonary oedema and death.

Preoperative 3D-CT bronchography and angiography facilitates single-direction uniportal thoracoscopic anatomic lobectomy.

Competency in video-assisted thoracoscopic surgery (VATS) lobectomy is estimated to be reached after 50 cases. Preoperative identification of individualized pulmonary vascular drainage is essential for the safe and fluent performance of single-direction uniportal VATS (UVATS) anatomic lobectomy. Digital anatomy models established by three-dimensional computed tomography bronchography and angiography (3D-CTBA) is therefore utilized to accumulate variations of the right upper lobe (RUL) veins, as right upper lobectomy is considered to be the most complicated and challenging procedure. This study aims to investigate the perioperative outcomes and learning curve of single-direction UVATS RUL lobectomy assisted with 3D-CTBA. The patients who underwent single-direction intercostal UVATS anatomic RUL lobectomy after 3D-CTBA simulation by the same surgeon at Xuzhou Central Hospital between January 2017 and April 2019 were retrospectively reviewed (3D-CTBA group), and consisted of 99 males and 54 females, with a mean age of 61.6 years, with the variations of the RUL vein being assessed preoperatively. They were further divided into group A (30 cases), B (30 cases), C (30 cases), and D (63 cases), in accordance with the order of surgery. Meanwhile, the first 35 cases of single-direction UVATS RUL lobectomy by another experienced surgeon (after the learning curve of this procedure) who did not use 3D-CTBA was enrolled as a control group. The operation time, intraoperative blood loss, stations and numbers of harvested lymph nodes, the incidence of conversion to multiport VATS or thoracotomy, thoracic tube retention for drainage, complications defined under the Clavien-Dindo system, pain score, and postoperative hospital stay were analyzed. The previous surgical experience of the two surgeons was also evaluated. A significant difference was evident among the 5 groups in terms of age, smoking history, the proportion of neoadjuvant chemotherapy, and T staging of the tumors (P<0.05, respectively). As for the 3D-CTBA group, a total of 29 cases (19.0%) of anomalous RUL posterior segmental pulmonary vein (PV) (V2) drainage were recorded, while the other 124 patients indicated the central type (V2a. Cent.). Of the uncommon RUL V2, they could be further classified into 4 types [V2a. Post. (5/153, 3.3%), VX2a. Ant. (17/153, 11.1%), VXX2a. Ant. (3/153, 2.0%), and nonspecific complicated (4/153, 2.6%)]. Single-direction UVATS lobectomy was performed in every patient successfully. No perioperative mortality, major bleeding, conversion to thoracotomy, the addition of incisions, or 30-day unplanned readmission was recorded. One patient in group B reported an injury of a bronchial artery. All cases had an R0 resection. The operation time of group A (109.8±25.4 min) was significantly longer than that of group B (79.7±11.1 min), C (77.0±12.1 min), D (69.3±16.0 min), and the control (86.1±17.9 min, P<0.001 respectively). Moreover, the operation time of the patients in group B, C, and D was slightly shorter than the control, although without significance (P>0.05, respectively). Furthermore, the duration of chest tube drainage in group A (3.7±2.2 days) was noticeably longer than that in group B (3.0±0.9 days), C (2.7±1.6 days), D (2.6±0.8 days), and the control (2.7±1.6 days, P=0.004 among the groups). Similarly, postoperative hospital stay in group A (3.9±2.3 days) was noticeably longer than that in group B (3.0±1.0 days), C (2.8±1.8 days), D (2.6±0.8 days), and the control (2.8±1.8 days, P=0.002 among the groups). The 5 groups indicated comparable stations and numbers of the harvested lymph nodes, intraoperative blood loss, postoperative total chest drainage volume, incidence of complications, and pain scale on the 14th day after surgery (P>0.05, respectively). Preoperative 3D-CTBA digital anatomy facilitates the safe and fluent performance of single-direction UVATS anatomic right upper lobectomy, with a learning curve of 30 cases. High-quality trials for better evidence are called for to verify these findings.

Combined clopidogrel and aspirin treatment up to surgery increases the risk of postoperative myocardial infarction, blood loss and reoperation for bleeding in patients undergoing coronary artery bypass grafting†

Recent guidelines suggest that patients undergoing coronary artery bypass grafting (CABG) should discontinue clopidogrel and aspirin (ASA) 5 and 2-10 days, respectively, before surgery to reduce postoperative bleeding and its complications. The aim of our study was to evaluate the relationship between the timing of discontinuing clopidogrel + ASA and early clinical outcomes in patients undergoing CABG. Four thousand three hundred and thirty consecutive patients underwent isolated CABG from April 2004 to February 2009. Of these, 926 patients received double antiplatelet therapy in the 14 days prior to surgery. Patients were stratified into three groups: clopidogrel + ASA within 5 and 2 days, respectively, before surgery (Group A, n = 287); clopidogrel within 5 days + ASA stopped 2-10 days before surgery or clopidogrel stopped 5 days + ASA within 2 days of surgery (Group B, n = 308) and clopidogrel + ASA discontinued >5 and 10 days, respectively, before surgery (control group, n = 331). Overall mortality was 0.8%. The incidence of postoperative myocardial infarction (MI) was 5.2, 1 and 1.8% in Groups A, B and control, respectively (P = 0.004). Reoperation for bleeding occurred in 4.5, 2.9 and 1.2% (P = 0.04) and total chest drainage was 761 ± 473, 720 ± 421 and 687 ± 302 ml in Groups A, B and control, respectively (P = 0.06). Multivariable analysis revealed that Group A was an independent predictor of postoperative MI (P = 0.02), reoperation for bleeding (P = 0.02), blood transfusions (P = 0.003) and blood losses (P = 0.015). Clopidogrel in combination with ASA up to the time of surgery is associated with an increased risk of postoperative MI, blood loss and reoperation for bleeding in patients undergoing CABG.

The effects of pulsatile flow characteristics on hemolysis, transfusion requirement, and hemostasis in open heart surgeries

Background: The aim of this study was to investigate the effects of pulsatile and nonpulsatile perfusion on hemolysis parameters and protection of blood components. Methods: This randomized, controlled and prospectively designed study included two independent groups, consisting of 27 nonpulsatile (NP) and 24 pulsatile (P) cases who had undergone open heart surgical procedures. Demographic and hemodynamic data were recorded. The effects of perfusion types were evaluated in terms of free hemoglobin (free Hb), haptoglobin (Hp), lactate dehydrogenase (LDH), potassium (K+), platelet number (plt) and urine Hb. These levels were measured in preoperative period, 30 and 60 minutes after initiation of cardiopulmonary bypass (CPB), two and 24 hours postoperatively. Also, total chest drainage and transfusion requirement were assessed. Results: Demographic and hemodynamic measurements did not differ between the groups. The mean arterial pressure of the NP group was statistically higher at the 30th minute. Free Hb, Hp, LDH and K+ levels did not differ in both groups in all time points. The urine Hb levels were significantly higher in the P group in the 30th minute. There was no difference regarding total chest drainage amounts and number of transfused erythrocyte cell packages. Conclusion: A clinically nonsignificant hemolytic effect of pulsatile perfusion can be outlined, although it is mentioned only in the urine Hb measurements on the laboratory basis.

Fibrin Sealant Provides Superior Hemostasis for Sternotomy Compared With Bone Wax

The purpose of this study was to evaluate the hemostatic efficacy and feasibility of direct injection of fibrin sealant into the sternal marrow cavity in senior patients undergoing on-pump coronary artery bypass grafting (CABG). A total of 82 senior patients undergoing on-pump CABG were randomized to the bone wax group (n=40) or the fibrin sealant group (n=42) for the period July 2010 to January 2011. The fibrin sealant-treated group had less chest drainage in the first 24 hours (186.67±49.53 versus 333.75±60.49 mL), less total chest drainage (326.19±67.24 versus 516±88.46 mL), less packed red blood cell (PRBC) administration (3.6±1.25 versus 7.4±2.13 U), less fresh frozen plasma (FFP) administration (5.52±1.64 versus 8.95±1.77 U), shorter intubation time (40.36±8.62 versus 46.25±10.46 hours), and shorter hospital stay (10.45±1.17 versus 11.03±1.37 days) compared with the bone wax group. No significant difference in the incidence of postoperative complications was found. Direct injection of fibrin sealant into the sternal marrow cavity significantly reduces the amount of postoperative blood loss and offers an attractive new treatment alternative for senior patients undergoing on-pump CABG.

Minimal Access Heart Surgery via Lower Ministernotomy: Experience in 460 Cases

Minimally invasive cardiac surgery has captured the interest and attention of cardiac surgeons throughout the world. We reviewed our experience of minimal access cardiac operations performed through a lower median ministernotomy. Between January 1997 and August 2003, 100 congenital, 178 valvular, 168 coronary, 12 aneurysmal, and 2 other operations were performed via a 6 to 9 cm lower ministernotomy in 460 consecutive patients. No special instruments were required. Four patients died, and 2 re-operations were necessary. Complications occurred in 28 patients (6.1%). The mean cardiopulmonary bypass time was 88.50 +/- 65.16 min, crossclamp time was 55.81 +/- 31.89 min, time to extubation was 14.71 +/- 29.33 h, and total chest drainage was 7.28 +/- 5.07 mL.kg(-1). Blood transfusions of 951.42 +/- 642.34 mL were needed in 282 patients. Postoperative hospital stay was 11.6 +/- 6.0 days. Our experience shows that many types of cardiac operations can be performed through a lower ministernotomy. This technique results in less trauma, quick recovery, and reduces the risk of infection and blood loss. It is a safe and easy procedure that can bring about favorable early outcomes in a wide range of cardiac operations.

Cardiac Troponin I Is an Independent Predictor of In-hospital Death after Adult Cardiac Surgery

Although myocardial injury during cardiac surgery is associated with impaired clinical outcome, little is known about the prognostic value of cardiac troponin I (cTnI), a cardiac-specific biologic marker. The purpose of this prospective study was to evaluate the prognostic value of cTnI concentrations measured 20 h after the end of surgery in adult patients undergoing coronary artery bypass grafting or conventional valve surgery. Baseline and perioperative characteristics of 502 consecutive patients undergoing conventional heart surgery during a 1-yr period were collected. In-hospital death (n = 28) and major clinical outcomes, e.g., low cardiac output, ventricular arrhythmia, and renal failure, were recorded. Multivariate analysis, using a stepwise logistic regression, showed that cTnI concentration was an independent predictor of in-hospital mortality (for cTnI concentration > 13 ng/ml, odds ratio = 6.7 [95% confidence interval, 2.3-19.3]), as were diabetes, altered preoperative cardiac function, emergent surgery, cardiopulmonary bypass duration, postoperative Pao2 level and total chest drainage volume. Further, elevated cTnI concentrations were associated with a cardiac cause of death and with major clinical outcomes. Our results demonstrated that cTnI concentration measured 20 h after the end of surgery is an independent predictor of in-hospital death after cardiac surgery. In addition, elevated concentrations of cTnI are associated with a cardiac cause of death and with major postoperative complications.

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Influence of normothermic systemic perfusion during coronary artery bypass operations: A randomized prospective study

Objectives: Normothermic cardiopulmonary bypass has been proposed as a more physiologic technique than hypothermic bypass for the maintenance of the body during cardiac surgery. The aims of this study were to investigate the effects of systemic perfusion temperature on clinical outcome after coronary revascularization. Methods: Three hundred patients (mean age 60 ± 9 years, 88% male) were prospectively randomized into three groups: hypothermia (28° C, n = 100), moderate hypothermia (32° C, n = 100), and normothermia (37° C, n = 100). All patients received cold antegrade St. Thomas' Hospital crystalloid cardioplegic solution, and patients in the normothermic group were actively rewarmed during cardiopulmonary bypass (nasopharyngeal temperature 37° C). Results: No differences were found between groups with respect to mortality (1%), intraaortic balloon pump use, perioperative infarctionrates, focal neurologic deficits (1%), intubation time, intensive care unit stay, and postoperative hospital stay. Further stepwise regression analysis identified age and intensive care unit stay as important predictors of the variability in postoperative stay (both R 2 = 0.114, p < 0.001), whereas perfusion temperature remained a nonsignificant explanator. Normothermic perfusion necessitated larger doses of phenylephrine to maintain arterial pressure above 50 mm Hg during cardiopulmonary bypass ( p < 0.0001 vs 28° C, p < 0.01 vs 32° C) but less requirement for electrical defibrillation during reperfusion ( p < 0.05 vs 32°C, p < 0.01 vs 28° C). Total chest drainage was not different between groups, but patients undergoing normothermic cardiopulmonary bypass required less transfusion of blood ( p < 0.05 vs 28° C and 32° C) and platelets ( p < 0.04 vs 32< C, p < 0.001 vs 28° C) in the postoperative period. Conclusions: Cardiopulmonary bypass temperature did not influence early clinical outcome after routine coronary artery bypass operations. Normothermic systemic perfusion was associated with an increased requirement for vasoconstrictors and reduced requirements for electrical defibrillation and transfusion of blood products. (J Thorac Cardiovasc Surg 1997;114:475-81)

Decreased postoperative drainage with addition of ϵ-aminocaproic acid before cardiopulmonary bypass

Desmopressin (DDAVP, 0.3 μg/kg) has been used routinely after cardiopulmonary bypass, particularly in patients having antiplatelet therapy Recently ϵ-aminocaproic acid (single dose of 5 g) given before cardiopulmonary bypass has been added to the protocol. One hundred consecutive patients taking desmopressin and ϵ-aminocaproic acid (group A) and another 100 taking desmo pressin alone (group B) were analyzed. There was no difference among these two groups in patient age, sex, preoperative history of bleeding and drug consumption, or number of patients for elective, urgent, emergent, redo, and reoperation for bleeding. Results of routine preoperative coagulation studies were within normal limits in both groups. Preoperative hemoglobin level was 13.5 g/dL in group A and 13.8 g/dL in group B ( p = 0.12). Estimated blood loss in the operating room was 513 mL for group A and 587 mL for group B ( p = 0.07). The total chest drainage at the end of 24 hours was 492 mL in group A and 746 mL in group B ( p = 0.0001). Amicar given before cardiopulmonary bypass does not lessen operating room blood loss, but significantly decreases postoperative chest drainage. Group B patients received more fresh frozen plasma (60 U versus 4 U), more platelets (130 U versus 16 U), and more cryoprecipitate (118 U versus 10 U) than group A patients. Adding ϵ-aminocaproic add could save $206.18 in blood product use per patient compared with the expense of $24.12 per patient for E-aminocaproic acid administration.