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Ann Thorac Surg 1999;68:2386
© 1999 The Society of Thoracic Surgeons

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Correspondence

Management of exsanguinating hemoptysis during cardiopulmonary bypass

^a Department of Surgery, St. Joseph’s Hospital, 50 Charlton Ave E, Hamilton, ON L8N 4A6, Canada
^b Department of Cardiothoracic Surgery, Buffalo General Hospital, Kaleida Health System, 100 High St, Buffalo, NY 14263, USA

e-mail: urschelj{at}fhs.mcmaster.ca

To the Editor

We read with interest the article by Smythe and coworkers on the management of exsanguinating hemoptysis during cardiopulmonary bypass [1]. They have correctly emphasized the value of rigid bronchoscopy in the airway management of these patients. One of their patients bled from a catheter-induced pulmonary artery rupture. This is a unique clinical scenerio and its management warrants further comment.

Catheter-induced pulmonary artery rupture in the setting of cardiopulmonary bypass typically manifests as hemoptysis during bypass weaning [2, 3]. Maintenance of gas exchange and arrest of hemorrhage are the two immediate management goals. Reinstitution of cardiopulmonary bypass prevents rapid death from asphyxia. It also permits appropriate airway interventions, including rigid bronchoscopy, under more controlled circumstances. The site of pulmonary artery injury can then be identified by a combination of bronchoscopy and intrapleural operative inspection. The pulmonary artery injury can be repaired, resected (lobectomy), or managed expectantly (protamine reversal) depending on the magnitude and site of injury [2–4]. The option of rapidly reinstituting bypass, in combination with airway interventions, should be emphasized.

References

1. Smythe W.R., Gorman R.C., DeCampli W.M., Spray T.L., Kaiser L.R., Acker M.A. Management of exsanguinating hemoptysis during cardiopulmonary bypass. Ann Thorac Surg 1999;67:1288-1291.[Abstract/Free Full Text]
2. Urschel J.D., Myerowitz P.D. Catheter induced pulmonary artery rupture in the setting of cardiopulmonary bypass. Ann Thorac Surg 1993;56:585-589.[Abstract]
3. Cervenko F.W., Shelley S.E., Spence D.G., Charette E.J., Salerno T.A. Massive endobronchial hemorrhage during cardiopulmonary bypass. Ann Thorac Surg 1983;35:326-328.[Abstract]
4. Urschel J.D., Parrott J.C.W. Repair of catheter-induced perforation of the pulmonary artery. Ann Thorac Surg 1991;51:1046.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): John D. Urschel Tomas A. Salerno Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Urschel, J. D. Articles by Salerno, T. A. Search for Related Content PubMed Articles by Urschel, J. D. Articles by Salerno, T. A. Related Collections Related Article