Retained Blood Syndrome after Cardiac Surgery: A New Look at an Old Problem

Abstract

<jats:p> Retained blood occurs when drainage systems fail to adequately evacuate blood during recovery from cardiothoracic surgery. As a result, a spectrum of mechanical and inflammatory complications can ensue in the acute, subacute, and chronic setting. The objectives of this review were to define the clinical syndrome associated with retained blood over the spectrum of recovery and to review existing literature regarding how this may lead to complications and contributes to poor outcomes. To better understand and prevent this constellation of clinical complications, a literature review was conducted, which led us to create a new label that better defines the clinical entity we have titled retained blood syndrome. Analysis of published reports revealed that 13.8% to 22.7% of cardiac surgical patients develop one or more components of retained blood syndrome. This can present in the acute, subacute, or chronic setting, with different pathophysiologic mechanisms active at different times. The development of retained blood syndrome has been linked to other clinical outcomes, including the development of postoperative atrial fibrillation and infection and the need for hospital readmission. Grouping multiple objectively measurable and potentially preventable postoperative complications that share a common etiology of retained blood over the continuum of recovery demonstrates a high prevalence of retained blood syndrome. This suggests the need to develop, implement, and test clinical strategies to enhance surgical drainage and reduce postoperative complications in patients undergoing cardiothoracic surgery. </jats:p>

Active Clearance of Chest Tubes Reduces Re-Exploration for Bleeding After Ventricular Assist Device Implantation

“…We analyzed the need for additional interventions for retained blood defined as any re-exploration for bleeding, delayed sternal closure (DSC), pericardial interventions for drainage (pericardial window or pericardiocentesis), and pleural interventions for drainage for hemothorax or bloody effusions. 8,12 Patients who had the diagnosis of pleural or pericardial effusion or hemothorax but did not undergo a specific invasive intervention or had conservative medical treatment ( i.e. , medications) were excluded.…”

“…Chest tubes can become clogged while the patient is still bleeding, leading to retained blood around the heart and lungs. 7,8 Current methods of clearing chest drainage catheters of clot, such as milking, stripping, and open suction are not beneficial, and can be harmful. 8,9 Studies have demonstrated that maintaining chest tube patency with active clearance can reduce the incidence of retained blood, however, protocols of actively maintaining chest tube patency have never been studied in a LVAD population.…”

“…7,8 Current methods of clearing chest drainage catheters of clot, such as milking, stripping, and open suction are not beneficial, and can be harmful. 8,9 Studies have demonstrated that maintaining chest tube patency with active clearance can reduce the incidence of retained blood, however, protocols of actively maintaining chest tube patency have never been studied in a LVAD population. 10–12 The purpose of this study was to evaluate if implementing a protocol to actively maintain chest tube patency reduces retained blood after LVAD implantation.…”

Postpericardiotomy syndrome and its complications: prevalence, clinical significance and management

“…One of the frequent causes of pericardial involvement is the retained blood syndrome (RBS) that develops due to obstruction of chest tubes by clot that initiates vascular endothelial growth factor inflammatory response resulting in increase of tissue exudative permeability and collection of blood in pleura and pericardium. It is observed in about 13.8-22% of patients undergoing surgery and intervention for pericardial effusion and tamponade are required in about 2.7-6.4% of patients (20,21). Its subacute form is associated with development of constrictive pericarditis in 1.2-2.0% of patients (21).…”

“…It is observed in about 13.8-22% of patients undergoing surgery and intervention for pericardial effusion and tamponade are required in about 2.7-6.4% of patients (20,21). Its subacute form is associated with development of constrictive pericarditis in 1.2-2.0% of patients (21). RBS is defined in presence of 2 of following signs: pleural effusion/ hemothorax requiring drainage, pericardial effusion requiring drainage, reexploration for washout of blood, interventions for postoperative pericardial constriction, interventions for postoperative fibrothorax.…”