Five-minute test to prevent postcardiotomy reexploration

Kunioka, Shingo; Shirasaka, Tomonori; Narita, Masahiko; Shibagaki, Keisuke; Kikuchi, Yuta; Saijo, Yasuaki; Kamiya, Hiroyuki

doi:10.1016/j.xjtc.2021.08.049

Cited by 4 publications

(3 citation statements)

References 23 publications

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“…When excessive bleeding is suspected the decision to perform re-opening after cardiac surgery is made according to the Kirklin and Barratt-Boyes criteria for reexploration. 19 Patients with severe haemodynamic instability had re-sternotomy (re-opening) in the intensive care (27.3%) as they were unstable for theatre transfer. We found that ICU re-opening was associated with significantly higher mortality rates (60%), indicating a higher risk and severity in these cases; while operative theatre re-openings had lower (23.53%); suggesting better outcomes.…”

Section: Discussionmentioning

confidence: 99%

Early chest re-exploration after adult cardiac surgery

Alshoubaki,

Al-Adwan,

Khasawne

et al. 2024

Int J Adv Med

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Background: Aim of the study was to determine the rate, causes, consequences of early re-sternotomy after cardiac surgery and to compare between re-opening in the operative theatre and re-opening in the intensive care unit (ICU). Methods: This is an observational retrospective study of adult cardiac surgical patients presenting for cardiac surgery at Queen Alia heart institute in the between September 2023 and February 2024. Incidence, risk factors, causes, site and consequences of early re-sternotomy are studied. Results: Data from 182 patients was analysed. Male patients were 82.4% and female patients were 17.6%. Reopening was needed in 12.1%. Incidence of reopening was highest after combined procedures (33.3%) and aortic surgery (33.3%). Reopening was performed in the operative theatre in 72.3% of cases, while 27.3% had reopening in the ICU. Risk factors for re-opening were longer average CPB (127 minutes vs 107 minutes) and aortic clamp times (71 vs 65 minutes). Patients who had reopening spent on average 55.45 hours on mechanical ventilation, while those who did not were extubated after 32 hours. The overall mortality rate was 11%; however, mortality in the reopening group was much higher (36.4%). Those who were reopened in ICU were at an older age (mean 61.6 vs 56.9 years), required more blood transfusions (mean 2.4 units vs 1.5 units) and had higher mortality (mean 60% vs 23.5%). Conclusions: Incidence of re-opening after cardiac surgery was 12.1%. The two main causes of re-opening were excessive bleeding and haemodynamic instability. Higher incidence of mortality was seen when re-opening took place in the ICU. Predictors for re-opening are old age, more complex (combined) procedures, aortic surgeries and prolonged cardiopulmonary bypass (CPB) and aortic cross clamp (ACC) durations.

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Section: Discussionmentioning

confidence: 99%

Early chest re-exploration after adult cardiac surgery

Alshoubaki,

Al-Adwan,

Khasawne

et al. 2024

Int J Adv Med

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“…In this issue of The Journal , Kunioka and colleagues 1 provide justification for the “five-minute test” (FMT) to reduce the incidence of re-exploration for bleeding after cardiac surgery. It is well established that re-exploration for bleeding portends significantly worse outcomes after cardiac surgery.…”

mentioning

confidence: 99%

Commentary: Good things come to those who wait

Vo¹,

Rubens²

2022

JTCVS Techniques

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“…Somehow, the maxim of “dry going in…dry going out” is not always followed and can then be compounded by delaying a necessary return to the operating room with attempts to avoid re-exploration by giving blood products. The authors of the article “Five-Minute Test to Prevent Post-Cardiotomy Re-Exploration” 1 did a retrospective analysis comparing 2 standards of care in 2 different time periods. Each time period was 2 years in length, with the control group comprising the first 2 years and the treatment group the second 2 years.…”

mentioning

confidence: 99%