title: Are chest compressions safe for the patient reconstructed with sternal plates? Evaluating the safety of cardiopulmonary resuscitation using a human cadaveric model.
abstract: BACKGROUND
  Plate and screw fixation is a recent addition to the sternal wound treatment armamentarium. Patients undergoing cardiac and major vascular surgery have a higher risk of postoperative arrest than other elective patients. Those who undergo sternotomy for either cardiac or major vascular procedures are at a higher risk of postoperative arrest. Sternal plate design allows quick access to the mediastinum facilitating open cardiac massage, but chest compressions are the mainstay of re-establishing cardiac output in the event of arrest. The response of sternal plates and the chest wall to compressions when plated has not been studied. The safety of performing this maneuver is unknown. This study intends to demonstrate compressions are safe after sternal plating.
  
  
  METHODS
  We investigated the effect of chest compressions on the plated sternum using a human cadaveric model. Cadavers were plated, an arrest was simulated, and an experienced physician performed a simulated resuscitation. Intrathoracic pressure was monitored throughout to ensure the plates encountered an appropriate degree of force. The hardware and viscera were evaluated for failure and trauma respectively.
  
  
  RESULTS
  No hardware failure or obvious visceral trauma was observed. Rib fractures beyond the boundaries of the plates were noted but the incidence was comparable to control and to the fracture incidence after resuscitation previously cited in the literature.
  
  
  CONCLUSIONS
  From this work we believe chest compressions are safe for the patient with sternal plates when proper plating technique is used. We advocate the use of this life-saving maneuver as part of an ACLS resuscitation in the event of an arrest for rapidly re-establishing circulation.
authors: Department of Surgery, Queen's University, Kingston, Ontario, Canada. doug.mckay@utoronto.ca
authors: Douglas R
authors: DR
authors: McKay
authors: Hosam F
authors: HF
authors: Fawzy
authors: Kathryn M
authors: KM
authors: McKay
authors: Romy
authors: R
authors: Nitsch
authors: James L
authors: JL
authors: Mahoney
mesh_terms: D001860:Bone Plates; D002102:Cadaver; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects*; D006336:Heart Massage / Q000009:adverse effects*; D006801:Humans; D008955:Models, Cardiovascular; D012449:Safety; D013249:Sternum / Q000601:surgery*; D035441:Thoracic Wall; D013908:Thoracotomy / Q000295:instrumentation*