Elsevier

Resuscitation

Volume 52, Issue 3, March 2002, Pages 269-272
Resuscitation

Survival to discharge following Open Chest Cardiac Compression (OCCC). A 4-year retrospective audit in a cardiothoracic specialist centre—Royal Brompton and Harefield NHS Trust, United Kingdom

https://doi.org/10.1016/S0300-9572(01)00479-8Get rights and content

Abstract

Objective: To review the use of Open Chest Cardiac Compression (OCCC) techniques in postcardiac surgical patients in one specialist cardiothoracic centre in the UK. Methods: A 4-year retrospective audit (April 1995–March 1999) of all cardiac arrest victims and resuscitation practice across two specialist cardiothoracic hospitals. Audit outcomes related to initial survival and survival to discharge, arrest rhythm, reasons for resternotomy, surgical procedure prior to resternotomy and time elapsed from original surgery to resternotomy. Results: Seventy-two patients (adult and paediatric) suffering cardiac arrest received OCCC following cardiac surgery. Thirty-three patients initially survived (46%) and 12 patients survived to discharge (17%). Discussion and recommendations: In the absence of current European Resuscitation Council guidelines, we adopted recommendations for resternotomy to be performed after 5 min of unsuccessful conventional CPR and OCCC initiated. An adapted ERC algorithm incorporating these recommendations can provide much needed direction in postcardiac surgery cardiac arrest victims.

Introduction

Survival to discharge is an important outcome in any part of medical and paramedical practice, particularly so in cardiac arrest victims. The Royal Brompton and Harefield NHS group of hospitals is well placed as one of the principal cardio-thoracic centres in Europe to conduct a retrospective audit of resuscitation practice, and in particular the use of OCCC techniques. Findings are unique to these centres but, recommendations made apply to a similar patient population in other cardiothoracic centres. This study is a 4-year retrospective audit, seeking to establish contemporary practice in relation to OCCC. The authors for some time have felt that it is important to have a protocol led approach, similar to many other areas of resuscitation practice that will both inform and guide resuscitation teams working with patients who have undergone cardio-thoracic surgery.

The primary aim of the study was to quantify initial survival and survival to discharge in patients receiving OCCC. Secondary aims were to look at both the trends and decision making process to starting OCCC and to establish available evidence to shape future protocol led practice.

Section snippets

Method

A 4-year retrospective audit was undertaken of all cardiac arrest victims who received (OCCC) between April 1995 and March 1999. During this period, approximately 2500 cardiac operations were performed annually, of which 75% were on adults. All patients undergoing postoperative cardiac surgery who required resternotomy for OCCC were included in the study. The audit included all age ranges, and focused on:

  • Initial survival and survival to discharge.

  • Initial arrhythmia at the onset of cardiac

Results

Seventy-two patients received OCCC during the audit period, 47 (65%) at the Royal Brompton and 25 (35%) at Harefield Hospital. Thirty-eight (57%) patients were classified as adults (>16 years of age) of which 27 (71%) were male. Of the remaining 34 (43%) patients who were classified as children, 17 (50%) were male. The patient profile regarding the surgical interventions can be seen in Fig. 1.

Initial survival within the patient population (n=72) who received OCCC following cardiac surgery was

Discussion and recommendations

Modern cardiopulmonary resuscitation (CPR) techniques can be traced back over the last 120 years when OCCC was first used in dogs with induced cardiac arrest [1]. Laboratory based experimentation enabled this development to be applied to human cardiac arrest victims, and in 1902 the first reported survivor was identified, and the use of OCCC by cardiac massage established as a means to sustaining life [2]. This method was used widely in many countries during the next 50–60 years until

Acknowledgements

The authors would like to thank all within the Trust for their support and encouragement. This paper was presented at the 5th Scientific Congress of the European Resuscitation Council, Antwerp, 2000.

Portuguese Abstract and Keywords
Objectivo: Rever a utilização de técnicas de Massagem Cardı́aca Interna (MCI) em doentes em pós-operatório de cirurgia cardı́aca num centro cardiotorácico especializado do Reino Unido. Métodos: Avaliação retrospectiva a 4 anos (Abril de 1995–Março de 1999) de todas as vı́timas de paragem cardı́aca e ressuscitação em dois hospitais cardiotorácicos especializados. Os resultados avaliados foram a sobrevivência imediata e à data da alta, o ritmo de paragem, as razões

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Portuguese Abstract and Keywords
Objectivo: Rever a utilização de técnicas de Massagem Cardı́aca Interna (MCI) em doentes em pós-operatório de cirurgia cardı́aca num centro cardiotorácico especializado do Reino Unido. Métodos: Avaliação retrospectiva a 4 anos (Abril de 1995–Março de 1999) de todas as vı́timas de paragem cardı́aca e ressuscitação em dois hospitais cardiotorácicos especializados. Os resultados avaliados foram a sobrevivência imediata e à data da alta, o ritmo de paragem, as razões para re-esternotomia, o procedimento cirúrgico prévio à re-esternotomia e o tempo decorrido entre a cirurgia original e a re-esternotomia. Resultados: Setenta e dois doentes (adultos e pediátricos) vitimas de paragem cardı́aca receberam MCI após cirurgia cardı́aca. Trinta e três doentes sobreviveram inicialmente (46%) e 12 doentes sobreviveram até à alta (17%). Discussão e recomendações: Na ausência de recomendações actuais do European Resuscitation Council, adoptámos a recomendação de realizar re-esternotomia e iniciar MCI após 5 min de RCP convencional sem sucesso. Um algoritmo ERC adaptado incorporando estas recomendações pode proporcionar a muito necessária orientação nas vı́timas de paragem cardı́aca após cirurgia cardı́aca.
Palavras chave: Massagem cardı́aca directa; Massagem cardı́aca externa; Algoritmo; Regresso a circulação espontânea.


Spanish Abstract and Keywords
Objetivos: Revisar el uso de técnicas de masaje cardı́aco a tórax abierto (OCCC) en pacientes post cirugı́a cardı́aca en un centro especializado cardiotorácico en el Reino Unido (UK). Método: Revisión retrospectiva de 4 años (Abril 1995–Marzo1999) de todas las vı́ctimas de paro cardı́aco y reanimación en dos hospitales de especialidad cardiotorácica. Los resultados de la revisión se relacionaron con sobrevida y sobrevida al alta, ritmo del paro, razones para esternotomı́a, procedimiento quirúrgico previo a la reesternotomı́a, y tiempo transcurrido entre la cirugı́a original y la reesternotomı́a. Resultados: Setenta y dos pacientes (adultos y pediátricos) que sufrieron paro cardı́aco después de la cirugı́a cardı́aca recibieron OCCC. Treinta y tres pacientes inicialmente sobrevivieron (46%) y 12 sobrevivieron al alta (17%). Discusión y recomendaciones: En ausencia de recomendaciones actuales del consejo europeo de resucitación, adoptamos la recomendación de realizar reesternotomı́a después de 5 minutos de CPR convencional e iniciar OCCC. Una adaptación del algoritmo del ERC incorporando esta recomendación puede proporcionar mucha de la directriz requerida en vı́ctimas de paro cardı́aco post cirugı́a cardı́aca.
Palabras clave: Masaje cardı́aco abierto; Masaje cardı́aco a tórax cerrado; Algoritmo; Retorno de Circulación espontánea

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