The safety of resternotomy in the intensive care unit for postcardiotomy bleeding control.
OBJECTIVE
This study aimed to investigate the efficiency and safety of resternotomy performed in the intensive care unit (ICU) for emergent bleeding control after cardiac surgery when transport of the patient to the operating room (OR) was unsafe or delayed.


METHODS
Medical records were retrospectively reviewed for 101 patients who underwent resternotomy for bleeding control after cardiac surgery between July 2003 and July 2013. A reoperation was performed in the OR for 61 patients (the OR group) and in the ICU for 40 patients (the ICU group). Perioperative features and outcomes were compared between the two groups.


RESULTS
The ICU group had a higher incidence of cardiopulmonary resuscitation before resternotomy (27.5% vs 3.3%, p < 0.05) and bleeding from the cardiac cannulation or suture sites (46.3% vs 23.3%, p < 0.05). Less time was needed for bleeding control in the ICU group (105.8 ± 40.0 min vs 144.3 ± 50.1 min, p < 0.05). There was no difference in 24-hour chest tube drainage, amount of red blood cell transfusion, need of second resternotomy, ICU and hospital stays, incidence of mediastinal infection (ICU 2.5% vs OR 4.9%, p = 0.542), superficial wound complications (ICU 12.5% vs OR 4.9%, p = 0.168), and in-hospital mortality rate (ICU 22.5% vs OR 13.1%, p = 0.218). Three deaths resulted from cardiac arrest, which occurred during the wait or transportation to the OR for a resternotomy in the OR group.


CONCLUSIONS
Resternotomy in the ICU was feasible and allows for more efficient management of bleeding-related instabilities without increasing the risk of infectious complications.
Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggido, Korea.
Dong Jung
DJ
Kim
Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggido, Korea.
Yoon Chul
YC
Shin
Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggido, Korea.
Dong Jin
DJ
Kim
Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggido, Korea.
Jun Sung
JS
Kim
Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggido, Korea.
Cheong
C
Lim
Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggido, Korea. drkhpark@gmail.com.
Kay-Hyun
KH
Park
D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000601:surgery*; D012086:Reoperation; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D056346:Sternotomy / Q000379:methods*; D016896:Treatment Outcome