Cardiopulmonary resuscitation after cardiac surgery has an incidence of 2%-3%. Signs of inadequate tissue perfusion, myocardial ischemia, and increased need for inotropic and mechanical support were predictive for postoperative hemodynamic collapse in our previous studies. Now we focused on complications related to this event and factors predictive for survival.
A total of 8807 patients underwent isolated CABG between 1988 and 1999. Unrelated to pericardial bleeding or tamponation, 76 (0.9%) faced sudden hemodynamic collapse resulting in open cardiac massage during the immediate postoperative course. Of these, 41 (54%) survived. We statistically compared survivors and non-survivors. Additional comparison was performed between all 76 patients facing hemodynamic collapse and 76 preoperatively matched controls.
In patients facing open cardiac massage, the rate of cardiac (85%/20%, p<0.0001), neurological (22%/4%, p=0.001), pulmonary (54%/5%, p<0.0001), and renal (15%/0%, p=0.001) complications was more frequent than in matched controls. Infections were more common (39%/5%, p=0.0001), additional surgery was more often required (41%/4%, p<0.0001), and both ICU stay (p<0.0001) and total hospital stay (p<0.01) were longer. Cardiopulmonary bypass time was longer (p<0.01) in non-survivors than in patients surviving open cardiac massage. Surprisengly, arterial grafts (internal thoracic and/or radial artery) were more frequently (p<0.05) used in survivors. Long-term survival turned out to be equal in open cardiac massage survivors and matched controls.
Sudden hemodynamic collapse resulting in need of open cardiac massage is fatal in almost one half of patients and leads in frequent complications and prolonged ICU and hospital stay. Despite the higher rate of complications, patients who survive this event reach excellent long-term result, which may at least partly be due to the frequent use of arterial grafts with well-known good long-term patency.
This study shows, that although the mortality rate of sudden hemodynamic collapse resulting in open cardiac massage and the rate of related complications is high, patients surviving reach a long term result comparable to that of patients undergoing CABG with uneventful postoperative course.
U. Salminen, None.