Five-minute test to prevent postcardiotomy reexploration

Abstract

Objective: To evaluate the effectiveness of the 5-minute test (FMT), developed to record the amount of pericardial bleeding in patients undergoing general cardiac surgery, and determine the relationship between this test and postcardiotomy bleeding.

Methods: The medical records of 573 patients who underwent adult cardiac surgery between January 2016 and December 2019 were reviewed retrospectively. Patients were divided into 2 groups: the FMT group included patients who underwent general cardiac surgery between January 2018 and December 2019 (n = 278), and the control group included patients who underwent general cardiac surgery between January 2016 and December 2017 (n = 295). The postcardiotomy reexploration rate due to intrapericardial bleeding or cardiac tamponade within 1 week after surgery and the amount of bleeding until 2 days after surgery were compared. The FMT procedure involved counting the amount of bleeding by packing 4 to 6 surgical gauze sheets for 5 minutes. Sternal closure was performed when the amount of blood measured by the FMT was <100 g.

Results: Compared with the control group, the FMT group had a significantly lower incidence of postcardiotomy reexploration (1.5% vs 5.7%; P = .007) and a reduced amount of bleeding after cardiac surgery (median, 1165 mL [interquartile range (IQR), 756.2-1743.8 mL] versus 1440 mL [IQR, 825.0-2130.0 mL]; P = .005). There was a significant positive correlation between the FMT gauze sheet weight and postcardiotomy bleeding (r = 0.322; P < .001).

Conclusions: The FMT is an objective and effective tool for estimating postoperative bleeding during cardiac surgery that can prevent postcardiotomy reexploration and reduce the amount of postcardiotomy bleeding.

Keywords: CHF, chronic heart failure; CPB, cardiopulmonary bypass; FMT, 5-minute test; ICU, intensive care unit; bleeding; cardiac tamponade; complication; perioperative care; postcardiotomy reexploration.

Graphical abstract

The 5-minute test reduces the need for postcardiotomy reexploration for bleeding.

Figure 1

Patient selection and study flow. MICS, Minimally invasive cardiac surgery; LVAD, left ventricular assisting device; ECMO, extracorporeal membrane oxygenation; FMT, 5-minute test.

Video 1

A brief video summary of the methodology, including how to apply the 5-minute test, and the main results of the study. Video available at: https://www.jtcvs.org/article/S2666-2507(22)00010-4/fulltext.

Figure 2

Postoperative findings. A, Postcardiotomy reexploration was significantly lower in the 5-minute test (FMT) group. B, The amount of bleeding after cardiac surgery was significantly lower in the FMT group. The upper and lower borders of the box represent the upper and lower quartiles, the middle horizontal line represents the median, the upper and lower whiskers represent the maximum and minimum values of nonoutliers. Extra dots represent outliers. C, Positive correlation between the weight of the FMT gauze sheets and postcardiotomy bleeding. D, The amount of FMT for each patient in FMT group; 85.6% of patients had a value <50 g.

Figure 3

We retrospectively reviewed patients who underwent cardiac surgery between 2016 and 2019. We started the 5-minute test (FMT) in 2018. Therefore, the FMT group comprised patients operated in 2018 to 2019. The middle picture shows the procedure on how to apply the FMT (packing 4-6 surgical gauze sheets into the pericardial sac for 5 minutes). We evaluated the rate of postcardiotomy reexploration for bleeding within 1 week after cardiac surgery; the rate of reexploration for bleeding was significantly lower in the FMT group, decreasing from 5.7% to 1.5%. The FMT reduces the requirement for postcardiotomy reexploration for bleeding.