Continuous postoperative pericardial flushing to reduce the risk of postoperative bleeding after elective adult cardiac surgery - a study-level meta-analysis.

Publisher: BioMed Central Country of Publication: England NLM ID: 101265113 Publication Model: Electronic Cited Medium: Internet ISSN: 1749-8090 (Electronic) Linking ISSN: 17498090 NLM ISO Abbreviation: J Cardiothorac Surg Subsets: MEDLINE

Original Publication: [London] : BioMed Central, 2006-

Cardiac Surgical Procedures*/adverse effects ; Elective Surgical Procedures*/adverse effects ; Postoperative Care*/methods ; Postoperative Hemorrhage*/prevention & control; Humans ; Pericardium

Competing Interests: Declarations. Ethics approval and consent to participate: As this is a study-level meta-analysis no ethics approval was needed from the local institution body and neither did we need any patient consent. Consent for publication: All authors consented to the publication of this manuscript. No patient related data is included in this study as it is a study-level meta-analysis and hence no consent was needed. Competing interests: The authors declare no competing interests.
Background: Retained blood syndrome contributes to higher morbidity and mortality post cardiac surgery. We investigate the benefits of continuous postoperative pericardial flushing (CPPF) over standard care chest drainage in elective adult cardiac surgery patients.
Methods: Various online databases were screened for randomised controlled trials (RCTs) and observations studies comparing CPPF to standard care.
Primary Outcomes: 12-hour and total blood loss, cardiopulmonary bypass (CPB) and aortic cross-clamp (ACC) times; surgical re-intervention for bleeding, mortality, sternal wound infections and pericardial or pleural fluid re-accumulation at discharge.
Secondary Outcomes: perioperative blood transfusion, time to extubation and total hospital stay.
Results: 586 patients from four studies with matched characteristics were included. CPPF was associated with less blood loss at 12 h and in total: Odds Ratio (OR) (95% CI) 0.71 (-0.91 to 0.51) and 0.49 (-0.67 to -0.32) (both p < 0.00001). CPPF had lower need for transfusion of blood products RR 0.57 (0.36-0.89) (p = 0.01)). There were no significant differences in surgical re-intervention rates, overall mortality, CPB, ACC times, length of hospital stay, time until extubation or sternal wound infections. Risk of pericardial or pleural fluid re-accumulation was lower in the CPPF groups RR 0.88 (0.80-0.97) (p = 0.01).
Conclusions: CPPF has shown promising results in reducing postoperative blood loss and fluid re-accumulation with fewer blood transfusions, and lower surgical re-intervention rates across all ranges of cardiac surgical procedures. It is safe, feasible and effective in all types of cardiac surgery, however further studies are needed to validate these findings.
(© 2025. The Author(s).)

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Keywords: Continuous postoperative pericardial Flushing; Mediastinal chest drain; Pericardial drainage

Date Created: 20250412 Date Completed: 20250413 Latest Revision: 20250415

20250415

PMC11993965

10.1186/s13019-025-03428-4

40221744