• Dong Jung Kim, Yoon Chul Shin, Dong Jin Kim, Jun Sung Kim, Cheong Lim, and Kay-Hyun Park.
• Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggido, Korea.
• J Card Surg. 2016 Nov 1; 31 (11): 672-676.

ObjectiveThis 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.MethodsMedical 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.ResultsThe 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.ConclusionsResternotomy in the ICU was feasible and allows for more efficient management of bleeding-related instabilities without increasing the risk of infectious complications.© 2016 Wiley Periodicals, Inc.

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