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Emergency Resternotomy in Post-operative Cardiac Surgery Patients Who Suffer Cardiac Arrest

  • Lu Wang
  • Joel DunningEmail author
Chapter
Part of the Difficult Decisions in Surgery: An Evidence-Based Approach book series (DDSURGERY)

Abstract

The Society of Thoracic Surgeons (STS) expert consensus statement published in 2017 established an algorithm of resuscitation for patients who suffer a cardiac arrest after cardiac surgery, based on best evidence available. These recommendations commence by aiming to address all possible quickly reversible causes of the arrest such as endotracheal tube displacement, tension pneumothorax, arrhythmia or pacing complication. However, once all quickly reversible causes of an arrest have been addressed, then early resternotomy is recommended for two reasons. First, the two most common causes for the irreversible arrest are that of a cardiac tamponade and a catastrophic bleeding event. For either of these eventualities, there is no alternative emergency treatment other than immediate resternotomy to relieve the tamponade or to stop the bleeding. Second, even in those patients who do not have a tamponade or bleeding event, cardiac massage is significantly more effective if performed internally rather than externally. We performed a literature review of studies exploring the outcomes of patients who arrest after cardiac surgery. We found 12 papers that are reviewed here to answer the clinical questions presented. Using these papers, we explored the rationale for early resternotomy. We also considered the alternatives, such as subxiphoid finger sweep and extracorporeal cardiopulmonary resuscitation (eCPR) with the use of extracorporeal membrane oxygenation (ECMO).

Keywords

Cardiac surgery Resuscitation Cardiac arrest Resternotomy Emergency thoracotomy Open cardiac massage Cardiac tamponade Extracorporeal cardiopulmonary resuscitation (eCPR) Extracorporeal membrane oxygenation (ECMO) 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Cardiothoracic SurgeryFreeman HospitalNewcastle upon TyneUK
  2. 2.Department of Cardiothoracic SurgeryJames Cook University HospitalMiddlesbroughUK

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