Cause Analysis and Treatment Strategies for Difficult Hemostasis in Emergency Cardiac Surgery

WAN Jing-wen; WU Bo; XU Li-jun

doi:10.3969/j.issn.1002-3429.2015.09.024

Abstract：Objective To examine the risk factors for difficult hemostasis in emergency cardiac surgery and evaluate the treatment strategy. Methods 41 cases were selected from 85 patients undergoing emergency cardiac operation during September 2010 and September 2014 in our hospital. It was considered as difficult hemostasis that if total time for hemostasis was over 2 h or 300 ml of blood loss during this period. Data was collected from the selected patients, risk factors related to difficult hemosta-sis in emergency cardiac surgery were indentified and effects of different measures for hemostases were evaluated. Results 21 cases undergoing Sun's operation for Aortic Dissection ( Debakery typeⅠ) , had difficult hemostasis, 7 cases were stoma hemosta-sis, among which, 5 cases with suture and blood transfusion comprehensive measures, the hemostasis was controlled;2 cases as-lo had difficult hemostasis with all measures tried, but fail to control the hemostasis, therefore gauze packing was used to deter hemostasis;14 cases of Debakery typeⅠand 17 cases of emergency coronary artery bypass and 3 cases of heart transplantation ex-perienced difficult hemostasis (major causes were leakage of anastomosis and angiostaxis of wound surface). All treatments of various measures for hemostasis ( eg. enhanced suture and multi-coagulant substance) were effective and only 2 patients died af-ter operation (1 patient undergoing Sun's operation died of multiple organ failure, another undergoing emergency coronary artery bypass died of low cardiac output syndrome). Conclusion Extracorporeal circulation, pathology and physiology of diseases, poor physical condition and preoperative anticoagulant usage are specific high risk factors of difficult hemostasis in emergency cardiac surgery, and multiple-treatments based on analysis of possible causes are effective to control difficult hemostasis.