No sternum CPR
- Thread starter joo
- Start date
I'm not sure how many people I could find without a sternum, but the whole point of compressions is to push the blood out of the heart. Not compressing as deep in this situation would be the same as not compressing as deep in someone with a sternum, there wouldn't be as much blood flow.
I probably explained that poorly. In either case, you're compressing the mushy part in the middle, you're not really compressing the sternum itself (okay, you're compressing it a veeeeery small amount), so you're compressing the heart an inch and a half in either scenario.
I would do CPR normally.
(Wow, what a strange "what if" situation.)
I probably explained that poorly. In either case, you're compressing the mushy part in the middle, you're not really compressing the sternum itself (okay, you're compressing it a veeeeery small amount), so you're compressing the heart an inch and a half in either scenario.
I would do CPR normally.
(Wow, what a strange "what if" situation.)
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Ridryder911
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I would say they are screwed. Sternotomy patients have just a flap of skin over the myocardium. So direct pressure will be placed upon the heart itself, I would assume lower pressure ratio as you described would be encouraged. The best way to gage would be to check perfusion levels per carotid pulse.
I have performed CPR on that type of patient as well as most post CABG (by-pass) patients have had sternectomy (albeit not removed) but cut through and wired.
R/r 911
I have performed CPR on that type of patient as well as most post CABG (by-pass) patients have had sternectomy (albeit not removed) but cut through and wired.
R/r 911
I want to clarify that I am NOT an EMT. I have a 22 yr old son without a sternum. I was looking up update articles to link in his medical file and saw your question. I will link to the article if that is permitted?https://www.resuscitationjournal.com/article/S0300-9572(08)00732-6/fulltext
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15 years......this has got to be a new record!
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You wish.
E tank
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with bots scrubbing the nets...we ain't seen anything yet...
CCCSD
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Or AI…
Jim37F
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Bit they did post a relevant academic paper to the original subject vs most necroposts...
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That's the only reason I didn't nuke the post.
CCCSD
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An old paper though.
NomadicMedic
I know a guy who knows a guy.
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This post piqued my interest—some interesting papers on this.
cardiothoracicsurgery.biomedcentral.com
academic.oup.com
This is a good review:
Abdominal only CPR during cardiac arrest for a patient with an LVAD during resternotomy: A case report - Journal of Cardiothoracic Surgery
We present a case in which a patient with a previous sternotomy and left ventricular assist device (LVAD) implantation developed cardiac arrest during resternotomy for LVAD exchange. The surgeon refused chest compressions for fear of potential damage to the inflow cannula directly beneath the...
cardiothoracicsurgery.biomedcentral.com
Guideline for resuscitation in cardiac arrest after cardiac surgery
Summary. The Clinical Guidelines Committee of the European Association for Cardio-Thoracic Surgery provides this professional view on resuscitation in cardiac a
academic.oup.com
This is a good review:
E tank
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Good discussion. One of the reasons I hang around this forum is that stuff comes up here that doesn't even on some medical forums I lurk on.
Those are some pretty impressive numbers on the monitor (figure 2 in the JTS case presentation) My guess is that the AO-CPR in this case is being mightily augmented by the LVAD they're in the OR to replace. Didn't see where that was noted, tho I might have missed that. I don't think someone should take away that Abdominal compressions can routinely give that category of coronary perfusion pressure. It was likely as much augmenting venous return to the heart so the LVAD could pump it out as retrograde aortic pulsatile perfusion from compressions.
As to the fresh sternotomy video, depending what the surgeon has done underneath it, for a witnessed arrest, I personally might go longer than a minute throwing pads on and shocking if it meant not disrupting something really important with free bone edges.
Doesn't mean much at all to the pre-hospital folks, but just to the point.... I brought a post op CABG to the ICU intubated and ventilated when the guy out of no where had V fib. He had pads on from the OR and had been on 100% for the transport so we had plenty of time to grab the defibrillator but convincing the bedside folks to not do compressions was pretty politically incorrect to say the least. He did get a couple of compressions anyway but everything turned out OK.
Those are some pretty impressive numbers on the monitor (figure 2 in the JTS case presentation) My guess is that the AO-CPR in this case is being mightily augmented by the LVAD they're in the OR to replace. Didn't see where that was noted, tho I might have missed that. I don't think someone should take away that Abdominal compressions can routinely give that category of coronary perfusion pressure. It was likely as much augmenting venous return to the heart so the LVAD could pump it out as retrograde aortic pulsatile perfusion from compressions.
As to the fresh sternotomy video, depending what the surgeon has done underneath it, for a witnessed arrest, I personally might go longer than a minute throwing pads on and shocking if it meant not disrupting something really important with free bone edges.
Doesn't mean much at all to the pre-hospital folks, but just to the point.... I brought a post op CABG to the ICU intubated and ventilated when the guy out of no where had V fib. He had pads on from the OR and had been on 100% for the transport so we had plenty of time to grab the defibrillator but convincing the bedside folks to not do compressions was pretty politically incorrect to say the least. He did get a couple of compressions anyway but everything turned out OK.