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Emergency thoracotomy in the surgical intensive care unit after open cardiac operation



Emergency thoracotomy in the surgical intensive care unit after open cardiac operation



Annals of Thoracic Surgery 32(4): 386-391



Out of 2112 patients who underwent open cardiac operation, 64 (3%) had 74 emergency thoracotomies in the surgical intensive care unit 10 min to 12 days after operation. In all instances, thoracotomy was performed for inadequate circulation. Patients were divided into 2 groups. In group 1, 44 patients suddenly and unexpectedly became hypotensive due to an arrhythmia (13 patients), sudden massive bleeding (15), suspected tamponade (6) or unexplained reasons (10). In group 2 (20 patients), circulatory insufficiency was progressive despite maximum pharmacological and intraaortic balloon support. Circulation was restored after 37 of the 74 thoracotomies (50%), including 8 in group 2. Nineteen patients (30%) were ultimately discharged; no patient in group 2 survived hospitalization. Of the 19 survivors in group 1, only 2 of the 13 with a sudden arrhythmia and 3 of the 10 with unexplained hypotension survived; 5 of the 6 with tamponade and 9 of the 15 with sudden massive bleeding survived. Overall, 43% of group 1 patients survived. Emergency thoracotomy in the surgical intensive care unit after open-heart operation may be lifesaving if performed promptly in patients with sudden, unexpected hypotension. The incidence of wound infection in survivors is 5% whether or not the chest is closed in the operating room.

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Accession: 005354291

Download citation: RISBibTeXText

PMID: 7305524

DOI: 10.1016/S0003-4975(10)61761-4


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