Chest compressions on open heart pt/sternectomy?

[graciev]

Is there a consensus on whether to do chest compressions during a code on a fresh open heart patient??? Or one who has had a sternectomy and "flap grafts"? We have been arguing over this for a while now. The doc's are also not consistent in their answers.

Thanks,

Gracie V:nurse:

[ghillbert, MSN, NP]

I don't mean to be dismissive, but I would be asking THIS patient's physician exactly what he means by a "full code" and having him/her document exactly what interventions they want done in case of arrest.

[vanders8]

Hi Ghillbert!

I totally understand the concern! I don't have access to the doctor or the chart. As a nursing student, our clinical instructor as us...to research this. I'm trying to see if anyone can help! I don't know why anyone living the life 'this patient has' -- ' no quality of life' would want him to be 'full code.!

Txs for your imput! VANDERS8:)

[APNgonnabe]

Vanders,

I guess I don't know enough about the pt you're referring to but I have seen several pt that had a sternectomy r/t infection that have had a long road but come back to visit us. I should add that they even walked down the hall to visit.

[ghillbert, MSN, NP]

In that case, perhaps consult a journal database to find evidence related to chest compressions following sternectomy?

[joeyzstj, LPN]

Our surgeons are pretty strict about not doing compressions unless the patient is 1-2 weeks post op, however we do it anyways most of the time until the surgeon gets to the room :)

[pnwccrn]

I have worked in CT ICU for close to 30 years. Many of the responses to CPR posted here have been for those with viable sternums. Patients who have sternectomies are in a gray zone. One could argue the outcome of doing compression is ugly, but not doing compressions is definitely DEATH, if meds and countershocks alone are useless. Frankly, most fresh flaps I have cared for had plenty of time to be relatively stable from a cardiac perspective. Fresh flaps could be ugly, mature flaps should be stable enough to use a single hand to do a modified compression. Modified in the sense of depth, rate is the cardiac output qualifier.

As for the post for open chest massage by the anesthesiologist; you need to use the four fingers of a single hand to push the heart forward against the chest wall for massage. You never want to be overly aggresive with direct contact with the heart. You never want to use the thumb in opposition or perferation is a high likelihood. Many CABG patients have friable myocardium from recent MI's and become tenuous for open cadiac massage. Just remember these patients are very sick and whatever your approach and outcome, you do what you can, doing nothing has an even more certain outcome.