UNEXPECTED CARDIAC-ARREST AFTER CARDIAC-SURGERY - INCIDENCE, PREDISPOSING CAUSES, AND OUTCOME OF OPEN-CHEST CARDIOPULMONARY-RESUSCITATION

Study objectives: To assess the incidence of acute mechanical causes p recipitating sudden cardiac arrest in cardiac surgery patients during the immediate postoperative period. In addition, we report the success rate of cardiopulmonary resuscitation (CPR) in which open-chest CPR w as employed at an early stage of the resuscitation effort. Methods: Da ta on all cardiac surgical patients who suffered a sudden cardiac arre st during the first 24 h after surgery were collected prospectively. C PR consisted of conventional closed-chest CPR initially-and was follow ed within 3 to 5 min, if needed, by open-chest CPR. Results: Of 3,982 patients undergoing cardiac surgery over a 30-month period, 29 patient s (0.7%) had a sudden cardiac arrest. Of these, 13 patients (45%) mere successfully resuscitated with closed-chest CPR, 14 (48%) with open-c hest CPR, and 2 (7%) died despite closed-and open-chest CPR. Four CPR survivors died subsequently in the ICU, yielding an overall hospital d ischarge rate of 79%. Perioperative myocardial infarction was the unde rlying cause of sudden cardiac arrest in 14 patients (48%), and mechan ical impediments to cardiac function (tamponade or graft malfunction) in another 8 (28%) patients; in the remaining 7 patients (24%), no und erlying cause was found. The length of ICU stay was 6+/-1 (mean+/-SE) days. None of the patients developed wound infection and all were neur ologically intact at hospital discharge. Conclusion: Mechanical factor s account for a substantial portion (28%) of causes of sudden cardiac arrest occurring in hemodynamically stable patients during the immedia te postoperative period. This high incidence, in conjunction with the high survival rate achieved by open CPR, supports an early approach to open-chest CPR in this group of patients.