Retained Blood Complex (RBC) is a common complication that impacts up to 20% of patients recovering form heart surgery. RBC occurs when postoperative blood is not entirely evacuated from around the heart and lungs by chest drains, often due to blood clots that form inside tubes. In serious cases, RBC can cause the need for supplemental procedures to evacuate the retained blood to restore proper function of the heart and lungs. In addition, RBC is associated with effusions (pleural and pericardial), atrial arrhythmias and potentially postoperative infections.
Drainage systems are used to evacuate blood from around the heart and lungs after cardiac surgery. If the drainage capacity exceeds the amount of bleeding, then the blood is fully evacuated. When the drainage capacity is impaired, for example by obstruction from chest tube clots, then blood is retained around the heart (pericardial space) and lungs (pleural spaces). Blood that is retained in these spaces cause a host of complications called retained blood complex (RBC), often impairing patient recovery. Blood that pools turns to clot. What is the fate of these clots in the pleural and pericardial spaces? It depends on the volume and location. Large volume clots must be surgically evacuated in
Bleeding is common after heart surgery. Patients with bleeding after heart surgery clearly have worse outcomes. But why? Theoretically, if a patient is bleeding and the chest tubes adequately drain the blood from around the heart and lungs while coagulation is restored and the blood products replaced, there should not be much impact on outcomes. This is clearly not the case, however. For example in a recent study by Chistensen and colleagues, postoperative hemorrhage (measured as chest tube drainage loss) exceeding 200 mL/h in 1 hour or 2 mL/kg for 2 consecutive hours occurring within 6 hours after cardiac surgery is associated with higher 30-day mortality and stroke, mechanical ventilation >