Mediastinal Bleeding Causes

Mediastinal Bleeding Causes:

**Coagulopathy 2° to CPB:

- hemodilution from crystalloid prime

- extracorporeal circuit triggers fibrinolysis

- heparinization causes platelet dysfunction

- depletion of coagulation factors and platelets from use of cell saving devices.

**Sugical Bleeding

- anastomotic sites

- sidebranches of arterial or venous conduits

- substernal soft tissues, sternal sutures sites, bone marrow, periosteum

- raw surfaces caused by previous surgery, pericarditis or radiation therapy

** anticoagulant effect related to heparin (residual or rebound)

** thrombocytopenia

** fibrinolysis

Mediastinal rexploration indications:

- Cardiac tamponade

- acute onset of rapid bleeding: >300 - 400 ml/hr, >200 ml/hr x3- 4 hrs