Dong Jung Kim1, Yoon Chul Shin1, Dong Jin Kim1, Jun Sung Kim1, Cheong Lim1, Kay-Hyun Park2. 1. Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggido, Korea. 2. Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggido, Korea. drkhpark@gmail.com.
Abstract
OBJECTIVE: This study aimed to investigate the efficiency and safety of resternotomy performed in the intensive care unit (ICU) for emergent bleeding control after cardiac surgery when transport of the patient to the operating room (OR) was unsafe or delayed. METHODS: Medical records were retrospectively reviewed for 101 patients who underwent resternotomy for bleeding control after cardiac surgery between July 2003 and July 2013. A reoperation was performed in the OR for 61 patients (the OR group) and in the ICU for 40 patients (the ICU group). Perioperative features and outcomes were compared between the two groups. RESULTS: The ICU group had a higher incidence of cardiopulmonary resuscitation before resternotomy (27.5% vs 3.3%, p < 0.05) and bleeding from the cardiac cannulation or suture sites (46.3% vs 23.3%, p < 0.05). Less time was needed for bleeding control in the ICU group (105.8 ± 40.0 min vs 144.3 ± 50.1 min, p < 0.05). There was no difference in 24-hour chest tube drainage, amount of red blood cell transfusion, need of second resternotomy, ICU and hospital stays, incidence of mediastinal infection (ICU 2.5% vs OR 4.9%, p = 0.542), superficial wound complications (ICU 12.5% vs OR 4.9%, p = 0.168), and in-hospital mortality rate (ICU 22.5% vs OR 13.1%, p = 0.218). Three deaths resulted from cardiac arrest, which occurred during the wait or transportation to the OR for a resternotomy in the OR group. CONCLUSIONS: Resternotomy in the ICU was feasible and allows for more efficient management of bleeding-related instabilities without increasing the risk of infectious complications.
OBJECTIVE: This study aimed to investigate the efficiency and safety of resternotomy performed in the intensive care unit (ICU) for emergent bleeding control after cardiac surgery when transport of the patient to the operating room (OR) was unsafe or delayed. METHODS: Medical records were retrospectively reviewed for 101 patients who underwent resternotomy for bleeding control after cardiac surgery between July 2003 and July 2013. A reoperation was performed in the OR for 61 patients (the OR group) and in the ICU for 40 patients (the ICU group). Perioperative features and outcomes were compared between the two groups. RESULTS: The ICU group had a higher incidence of cardiopulmonary resuscitation before resternotomy (27.5% vs 3.3%, p < 0.05) and bleeding from the cardiac cannulation or suture sites (46.3% vs 23.3%, p < 0.05). Less time was needed for bleeding control in the ICU group (105.8 ± 40.0 min vs 144.3 ± 50.1 min, p < 0.05). There was no difference in 24-hour chest tube drainage, amount of red blood cell transfusion, need of second resternotomy, ICU and hospital stays, incidence of mediastinal infection (ICU 2.5% vs OR 4.9%, p = 0.542), superficial wound complications (ICU 12.5% vs OR 4.9%, p = 0.168), and in-hospital mortality rate (ICU 22.5% vs OR 13.1%, p = 0.218). Three deaths resulted from cardiac arrest, which occurred during the wait or transportation to the OR for a resternotomy in the OR group. CONCLUSIONS: Resternotomy in the ICU was feasible and allows for more efficient management of bleeding-related instabilities without increasing the risk of infectious complications.