Emergency exploratory sternotomy: the nurse's role

Emergency exploratory sternotomy (EES) is a life-saving procedure performed in the recovery room or ICU within the first 24 hours following cardiac surgery. Complications that may necessitate this procedure include: tamponade, hemorrhage, acute profound hypotension, atypical tamponade, coronary artery spasm, clotted grafts, refractory dysrhythmias, and cardiac arrest. The nurse plays an important role in the early recognition of these life-threatening situations and therefore must be able to recognize clinical signs that may preclude the need for EES. This article details the four clinical scenarios the nurse will see, which are: (1) cardiac tamponade, (2) acute profound hypotension where the etiology is unclear, (3) cardiac arrest unresponsive to standard CPR and drug therapy, and (4) acute massive hemorrhage where tamponade is not the primary presenting condition. The procedure for EES is discussed, including preprocedure preparations, the nurse's role in EES, and the post-EES nursing assessment. Nursing diagnoses appropriate to this event are outlined. There is a discussion on how to educate staff on EES as well as a discussion of the research outcomes of EES. Nurses caring for adult and pediatric cardiac surgery patients will find this information useful in establishing protocols for EES as well as in educating staff on how to respond effectively during this life-threatening event.