INTRODUCTION. Emergency resternotomy(ER) is a multi-practitioner procedure, which should ideally be rapidly performed after cardiac surgery in the Intensive Cares Unit (ICU), due to tamponade and major bleeding. ER may be required in 0.8-2.7% of all patients undergoing cardiac surgery. As resternotomy is not an often procedure, it might be an integral part of successful resuscitation after cardiac surgery. Because of the absence of an actuation protocol and larger sets that could confuse staff unaccustomed to assisting in theatres, we decided to present an update protocol to improve our actuation in ER.
OBJECTIVES. To develop an operating procedure based on a multidisciplinary decision algorithm to supply a rapid and effective response to ER. And make a check list to evaluate the procedure.
METHODS. Literature review. Advice from nursing surgical personnel, cardiothotracic surgeon and intensive clinician personnel. Multidisciplinary meetings.
RESULTS. This protocol has been successfully created and has had a great acceptation among the ICU team. To evaluate the effectiveness of this protocol we have set a check list which allow the quality and health cares be checked.
CONCLUSIONS. Using the ER protocol and the update knowledge of the guidelines provide a structured actuation. The check list will improve the material management and the global actuation.
(1) Joel Dunninga, Alessandro Fabbrib, Philippe H. Kolhc, Adrian Levine, et.al., Guideline for resuscitation in cardiac arrest after cardiac surgery. European Journal of cardio-thoracic surgery 2009, 36: 3-28.
(2) Soar J, Deakin CD, Nolan JP, Abbas G, Alfonzo A, Handley AJ, Lockey D,Perkins GD, Thies K, European RC. European Resuscitation Councilguidelines for resuscitation 2005. Section 1. Executive summary. 2010;81(Suppl. 1):1219—1276.
(3) Anthi A, Tzelepis GE, Alivizatos P, Michalis A, Palatianos GM, GeroulanosS. Unexpected cardiac arrest after cardiac surgery: incidence, predisposing causes, and outcome of open chest cardiopulmonary resuscitation. Chest 1998;113(1):15—9