Management of persistent microvascular bleeding after cardiopulmonary bypass

An institutional goal-directed algorithm is useful to manage persistent microvascular bleeding (defined as bleeding without an apparent surgical site) after cardiac surgery with CPB, and guide appropriate intraoperative transfusion decisions. This example is based on results of point-of-care and standard laboratory test results.

ABG: arterial blood gas; ACT: activated whole blood clotting time; aPTT: activated partial thromboplastin time; CPB: cardiopulmonary bypass; EACA: epsilon-aminocaproic acid; FFP: fresh frozen plasma; Hgb: hemoglobin; INR: international normalized ratio; IU: international units; PCC: prothrombin complex concentrate; RBCs: red blood cells; ROTEM: rotational thromboelastography; TEG: thromboelastorgraphy; TXA: tranexamic acid.

* Refer to UpToDate topics regarding management of hypothermia after CPB and perioperative temperature management.

¶ Refer to to UpToDate topics on reversal of anticoagulation, management of intraoperative bleeding, and transfusion of blood products after CPB.

Δ Refer to UpToDate topics on point-of-care hemostasis testing (viscoelastic tests such as TEG and ROTEM).

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Management of persistent microvascular bleeding after cardiopulmonary bypass

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