Packing of the Chest as Last Resort to Control Bleeding in Thoracic Surgery

Objectives: Severe pleural empyema, thoracic trauma, anticoagulation therapy and liver cirrhosis are associated with a high risk of uncontrolled bleeding in thoracic operations. Packing is an established treatment in patients with the same problems at the liver. Removal of the abdominal bandages requires a second operation. In thoracic surgery, this procedure is not established in routine practice. In general, these conditions are associated with extremely high mortality. There are no established evidence-based treatment algorithms or randomized clinical trials. Thus far, only a few small reports exist in the literature. We analyzed the outcome of our packing strategy in thoracic surgical patients.

Methods: We retrospectively analyzed all 64 patients treated with a packing strategy over a period of 4 years. Patient demographics, operations, clinical course and mortality were evaluated.

Result: The majority of the patients were male 81.3%, (female 18.7%) and mean age was 59.5 ± 15.5. Indications for the procedure were stage III empyema (59%), hemothorax (36%), and pneumothorax 6%. 28 patients (43.8%) had an oncological underlying disease, 34 (53.1) had significant anticoagulation therapy and 7 (10.9%) clotting disorders. During the operations, an average of 3.3 ± 1.5 abdominal bandages was left in the hemithorax (right 62.5%, left 37.5%). De-Packing was performed in average 56 hours later. Median length of postoperative hospitalization was 14.8 ± 14.3 days and hospital mortality was 39.1%. Anticoagulation therapy and the need of a second packing (12%) were identified as significant risk factors.

Conclusion: Patients with severe thoracic bleeding who cannot be conventionally controlled carry a high risk. A packing strategy seems to be an option in these last resort situations. Although it was associated with a high mortality, 61% of the patients survived in our collective.

Publication History

Article published online:
19 February 2021