Diagnostic evaluation of risk for bleeding in cardiac surgery with extracorporeal circulation.
Damaris Vieira Braga, Marcos Antônio Gomes Brandão
PMID 30517580WHAT IT FOUND
In 216 cardiac surgery patients, low body mass index, longer extracorporeal circulation time, lower esophageal temperature, postoperative acidosis, and longer activated partial thromboplastin time were associated with excessive bleeding.
These are nursing warning signs, not proven causes.
Key findings
01Body mass index below 26.35 kg/m², extracorporeal circulation time above 90 minutes, esophageal temperature below 32°C, metabolic acidosis, and activated partial thromboplastin time above 40 seconds were associated with excessive bleeding.
02Return to the operating room was reported in 7 of 24 cases and 0 of 192 controls.
03Age, sex, hypertension, hematocrit, platelet count, and surgery time did not show statistically significant associations in the table analyses.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was retrospective and relied on medical charts, so missing or inaccurate records could have affected the results. Only 24 patients had excessive bleeding, so the confidence intervals were wide and the estimates are imprecise. Fourteen incomplete charts and 22 unavailable charts were excluded, so the analysed sample was not all eligible surgeries. Excessive bleeding was defined by chest tube drainage thresholds chosen by the authors, and the paper notes that other studies use different definitions. The study was done at one hospital, so its findings may not apply to other patient groups or units.
The easy way to misread this
Do not treat these variables as proven causes or a validated bleeding-risk tool. They were associations from retrospective charts of 24 cases.