Infectious Complications and Cost-Effectiveness of Open Resuscitation in the Surgical Intensive Care Unit after Cardiac Surgery

https://doi.org/10.1016/S0003-4975(10)60075-6Get rights and content

Abstract

From July, 1982, to May, 1984, 2,412 patients underwent cardiac surgery. Open resuscitation through a midline sternotomy was performed in the surgical intensive care unit (SICU) 88 times in 64 patients one minute to 10 days after admission. There were 49 initial survivors; 31 patients had primary closure in the SICU (Group 1), and 18 patients had delayed closure (Group 2). In Group 1 there was 1 death. Wound infection developed in 2 of the 30 survivors—Escherichia coli in 1 and Staphylococcus epidermidis in 1. The latter required subsequent debridement. In Group 2 there were 8 survivors and no wound infections. Fifteen patients could not be resuscitated because of ventricular arrhythmia (13%), asystole (33%), cardiogenic shock (47%), and tamponade (7%). Only 2 of 38 patients, or 5%, experienced wound infections. This study demonstrates that open resuscitation in the SICU is a safe, rapid, and cost-effective procedure that will allow earlier intervention, diagnosis, and treatment. In no instance was death attributed to wound infection, and at our institution, this method resulted in cost savings of more than $1,000 per patient.

References (12)

There are more references available in the full text version of this article.

Cited by (28)

  • The Society of Thoracic Surgeons Expert Consensus for the Resuscitation of Patients Who Arrest After Cardiac Surgery

    2017, Annals of Thoracic Surgery
    Citation Excerpt :

    Once the chest has been opened, this set can be discarded and a full set opened in a more measured fashion. This concept is not new and dates back to 1985 [48]. Emergency resternotomy is required for 20% to 50% of cardiac arrests after cardiac surgery [8, 14]; and it is a multipractitioner procedure that should ideally be performed as rapidly as possible using full aseptic technique.

  • Long-Term Outcomes of Patients Who Had Cardiac Arrest After Cardiac Operations

    2016, Annals of Thoracic Surgery
    Citation Excerpt :

    Our results from a small but important subgroup extend these results to patients who had postoperative cardiac arrest. The incidence of cardiac arrest after cardiac operations has previously been reported to be as high as 5%, with emergency operations, low preoperative ejection fraction, higher New York Heart Association class, myocardial infarction, renal dysfunction, and non-CABG cardiac operations being important risk factors [1–7]. Further, the rate of failure to rescue in this population has been reported to be as high as 60% [3].

  • European Resuscitation Council Guidelines for Resuscitation 2015. Section 4. Cardiac arrest in special circumstances

    2015, Resuscitation
    Citation Excerpt :

    Discuss and agree on the time at which the DNAR decision is reinstated.445 Cardiac arrest following major cardiac surgery is relatively common in the immediate post-operative phase, with a reported incidence of 0.7–8%.446–455 It is usually preceded by physiological deterioration,456 although it can occur suddenly in stable patients.452

  • Current trends in preoperative, intraoperative, and postoperative care of the adult cardiac surgery patient

    2015, Current Problems in Surgery
    Citation Excerpt :

    Re-exploration in the ICU is associated with a high survival rate compared with emergency thoracotomy for lethal arrhythmia, or MI.72 There is evidence that early re-exploration for bleeding may reduce blood transfusions, the risk of respiratory insufficiency, and the rate of infection for undrained hematoma.73-75 Outside the operating room, many centers are developing protocols to provide MCS devices to the sickest patients.

View all citing articles on Scopus

Presented at the Twenty-first Annual Meeting of The Society of Thoracic Surgeons, Phoenix, AZ, Jan 21–23, 1985.

View full text