Management of exsanguinating hemoptysis during cardiopulmonary bypass

Background. Large-volume hemoptysis during cardiopulmonary bypass is an inf requent, but life-threatening event. Rapid airway clearance and control are the primary prerequisites for successful management. Methods. The cases of 3 patients with different sources of exsanguinating h emoptysis during cardiopulmonary bypass managed initially with rigid bronch oscopy were reviewed. Results. In all patients, airway control was rapidly established and weanin g from cardiopulmonary bypass CPB was accomplished. Two patients survived t he operative procedure. The other patient died in the operating room of unr emitting bilateral pulmonary hemorrhage. Conclusions. Major hemoptysis during cardiopulmonary bypass is best dealt w ith initially by rapid airway control and cessation of bypass in an expedit ious manner. An algorithm for suggested management is provided. The rigid b ronchoscope is the optimal tool for initial management and it should always be available. Definitive treatment is determined by the cause and the pers istence of hemorrhage once these maneuvers have been performed. (Ann Thorac Surg 1999;67:1288-91 (C) 1999 by The Society of Thoracic Surgeons.