Cardiac arrest due to major bleeding during mediastinal irrigation for poststernotomy mediastinitis: a case report

Abstract

　We report the case of a 84-year-old female who developed cardiac arrest due to major bleeding during mediastinal irrigation for poststernotomy mediastinitis after cardiac valve surgery. The treatment of poststernotomy mediastinitis requires antibiotic therapy, reoperation, debridement, and mediastinal irrigation, followed by vacumm-assisted closure. Mediastinal irrigation often has a short operation time, and hence, a central venous catheter and transesophageal echocardiography are not routinely employed during this procedure. However, incidence of major bleeding as a complication of poststernotomy mediastinitis has been reported to be 5.3%, and mortality varies from 33% to 53%; therefore it is necessary to prepare for management of major bleeding during mediastinal irrigation. In this case, placement of a large-bore intravenous line prior to beginning irrigation would have been appropriate approach. Safe and effective anesthetic protocol for patients with poststernotomy mediastinitis after cardiac surgery should involve measures such as placement of an intravenous line to manage major bleeding and to prepare for cardiac surgery.