by mcknis

Just curious if a pt is a fresh CABG what risks do we encounter when performing manual compressions with CPR? Reason for the question is my grandfather jsut went througha valvuloplasty and CABG so his incision is fairly new, but would their be any complications if CPR was performed directly over the incision. I have been tossing these thoughts over and over in my mind for quite some time, but can't figure out the solution in my mind. Any help is much appreciated.

Thanks

Re: Chest compressions s/p open heart

Yes, there could be problems with a fresh sternum. There is also the option of reopening the chest (emergent sternotomy). Either option is of course better than dead.

Re: Chest compressions s/p open heart

Originally Posted by ghillbert

Yes, there could be problems with a fresh sternum. There is also the option of reopening the chest (emergent sternotomy). Either option is of course better than dead.

... and death is not an option.. lol

Re: Chest compressions s/p open heart

It is a little bit easier to do chest compressions on a fresh sternontomy...

You do CPR just like normal, hard and fast. Better to perfuse and live to deal with the incision than end up dying. In one code I ended up doing compressions on a fresh CABG. A week or two later when he returned from the ICU (yes, he survived fairly intact...) I was helping his nurse do some A.M. care adn he says, pointing to his chest, "Be careful, I'm a little sore right through here." I wanted to say, "Sorry, that would be my fault..." but I held back.

I agree, death is not an option.

Tom

Re: Chest compressions s/p open heart

I've done a little CVICU, and was taught to compress just as usual. Keep in mind, that proper technique is even more vital, and that it will be noticeably easier to compress. If they survive, then it's off to the OR to explore the chest and try to fix any new boo boo's created.
In hospital, you'd hope to get the surgeon to the bedside and open the chest before they code. Out of hospital, treat them like any other cardiac arrest.

Re: Chest compressions s/p open heart

I have had a post op cabg of not even an hour go into vfib... Think about your question... Your pt codes regardless of being a cabg or not you should start CPR. More likely then not the chest will be reopened but you should try to preserve the brain if possible! I started CPR and the pt chest was opened. Of course there are complications of doing compressions but what is your other option?

Re: Chest compressions s/p open heart

Originally Posted by Wile E Coyote

In hospital, you'd hope to get the surgeon to the bedside and open the chest before they code.

I've never seen/heard of the surgeon opening the chest at the bedside unless the patient is coding. If the patient was bleeding they would go back to the OR, right? Other than a cardiac arrest, why would you need to emergently open the chest?

Re: Chest compressions s/p open heart

My pt was coding... Otherwise there is no reason to open the chest of the pt is bleeding they should go back to the or. The icu is not the or you are missing a lot of important equiptment they need! But you are right no other reason but cardiac arrest is a reason to do an emergent sternotomy.

Re: Chest compressions s/p open heart

I agree that if they are asystole or non shockable, a cracked sternum is oreferable t death. However, always shock first. We even have a surgeon who encourages shocking asystole as "you can't hurt anything". Occasionally it stimulates a little something and you have a rhythm ( a gross one but better than nothing).

Re: Chest compressions s/p open heart

Originally Posted by nursejill155

My pt was coding... Otherwise there is no reason to open the chest of the pt is bleeding they should go back to the or. The icu is not the or you are missing a lot of important equiptment they need! But you are right no other reason but cardiac arrest is a reason to do an emergent sternotomy.

We have opened a chest or two (actually quite a lot of them) at the BS...I should say "Re OPen". It is scary. We have done it for code situations, and bleeds, and tamponade. We have also opened bellies for Compartment syndrome. It is freaky, even for me, and I have 14 years of OR experience (scrubbing and FA). It is not optimal. I work in a very large hospital, and the OR is 11 floors down. If the pt is really that unstable, we do it at the BS. We even have a cart dedicated to opening a chest at the BS. It is usually a total clust!!

Believe it or not though, I was taught that if you have a fresh pump, and I mean very fresh, you should use a Bed Pan (clean of course) to do compressions. The reason for this is for the nurse doing the compressions...the sternal wires could break and pierce the person doing compressions....I am certainly not advocating this as the proper technique, I'm just saying...But I will say that I've never actually seen it done.