The Annals of Thoracic Surgery, Vol 32, 386-391, Copyright © 1981 by The Society of Thoracic Surgeons
Emergency thoracotomy in the surgical intensive care unit after open cardiac operation
RM Fairman and LH Edmunds Jr
Since January, 1977, 64 patients (3%) out of 2,112 who underwent open
cardiac operation had 74 emergency thoracotomies in the surgical intensive
care unit 10 minutes to 12 days after operation. In all instances
thoracotomy was performed for inadequate circulation. Patients were divided
into two 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; however, 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. However, 5 of the 6 with tamponade and 9 of the 15 with sudden
massive bleeding survived. Overall, 43% of Group 1 patients survived. We
conclude that 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 in 5% whether or not the chest is closed in the
operating room.
