Emergency thoracotomy in the surgical intensive care unit after open cardiac operation

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.