Cardiac Arrest Following Sternotomy - Changing the Norm

Background: Controversy exists regarding the use of CPR in the post-operative cardiac surgery patient due to the risk of serious complications, even death. Internal compressions and direct cardiac massage have been studied as an alternative to traditional closed-chest CPR in this patient population. Purpose: This presentation reviews the research to consider the impact of internal cardiac massage on mortality and the implications for practice. These considerations have posed the following PICO question: In adult patients recovering from sternotomy requiring cardiopulmonary resuscitation (P), how does the use of cardiac massage (I) compared with standard external compressions (C) affect mortality rates (O)? Method: An exhaustive search on Summon, Medline, UpToDate, and CINAHL. Search terms included sternotomy, cardiac arrest, re-sternotomy, internal cardiac massage, open-chest CPR, care of post-operative cardiac surgery. Time frames were limited to 2002-2017. In total, 103 abstracts were reviewed, and 10 articles selected according to relevancy to PICO question. Results: The majority of studies reviewed support the use of early defibrillation and internal cardiac massage over external compressions. Outcomes include increased coronary perfusion pressures, increased cerebral perfusion pressures, and early identification of cause of arrest. Conclusion: Evidence supports the initiation of early defibrillation, re-do sternotomy, and internal cardiac massage in most patients recovering from cardiac surgery. Implications to practice are discussed and recommendations are provided for the three-shock, open chest, internal massage protocol