The question of performing Cardiopulmonary Resuscitation (CPR) on an individual who has had open heart surgery is a serious concern for lay rescuers and healthcare providers alike. Cardiac arrest demands immediate action to maintain blood flow to the brain and other organs, but past surgery introduces a unique consideration. Open heart procedures involve cutting and repairing the sternum, or breastbone, leading to hesitation about applying the necessary force for chest compressions. This article confirms that the life-saving necessity of CPR almost always overrides potential fears about previous surgical sites.
The Core Concern: Sternal Wires and Healing
Open heart surgery requires a median sternotomy, where the sternum is vertically divided to allow access to the heart. Following the operation, the two halves of the breastbone are rejoined using several stainless steel or titanium sternal wires. These wires are twisted tightly and designed to hold the bone fragments together while the sternum heals.
The sternum’s initial recovery period takes eight to twelve weeks, during which the patient limits upper body movement. Complete bony fusion, however, can take many months or even years. This extended healing process causes public concern, as applying significant force to a chest held together by wires seems dangerous. The fear is that chest compressions could cause the wires to break, the sternum to separate, or injure the heart or lungs.
Standard CPR Protocols Apply
For a layperson encountering sudden cardiac arrest outside of a hospital setting, the definitive answer is to perform immediate CPR using the standard protocol. The American Heart Association (AHA) guidance does not modify the technique for a patient with a history of open heart surgery. The risk of death from inaction in a cardiac arrest scenario is virtually certain, far outweighing the risk of complications at the surgical site.
High-quality chest compressions are delivered to the center of the chest at a rate of 100 to 120 compressions per minute. The depth should be at least two inches for an adult, ensuring the sternum is depressed sufficiently to pump blood. Hesitation or a reduced compression depth, driven by fear, significantly decreases the chance of survival. The sternal wires, while holding a healing bone, are robust and designed to withstand substantial pressure.
The standard technique effectively circulates oxygenated blood, which is the immediate priority for survival. If the patient has been discharged for several weeks or months, the sternum has achieved stability. Any potential damage to the healing bone or wires is considered a manageable medical complication compared to the irreversible consequences of brain death.
Timing Matters: Immediate Post-Operative Period
A distinction exists between performing CPR on a patient who had surgery years ago and one who is in the immediate post-operative phase. This phase typically refers to patients still hospitalized, particularly within the first ten days of their procedure. In this controlled environment, specialized medical teams follow distinct protocols, such as Cardiac Advanced Life Support (CALS).
In the hospital, the cause of arrest may be related to a specific surgical complication, like fluid buildup around the heart or hemorrhage. For witnessed arrests, medical staff may prioritize immediate defibrillation or pacing through temporary wires placed during surgery. External chest compressions may be delayed for up to one minute while troubleshooting or preparing for an emergency resternotomy, which is the surgical reopening of the chest.
An emergency resternotomy, performed by a surgeon, allows for direct access to the heart for internal cardiac massage. This specialized approach is only relevant to hospital staff in a cardiac care unit. For the average lay rescuer outside of the hospital, the general rule of immediate and standard CPR still applies, as there is no way to know the patient’s recovery timeline or the specific cause of the arrest.
Addressing the Fear of Injury
The psychological barrier to performing CPR on a post-surgical patient is understandable, but rescuers must focus on the outcome. The primary goal of CPR is perfusion: getting blood to the brain and other vital organs. Without effective compressions, the patient will not survive regardless of the condition of their sternal wires.
While there are rare reports of sternal wires breaking or protruding during compressions, this is an acceptable risk when weighed against the alternative. A broken wire or a sternal re-injury is a fixable orthopedic issue; death from cardiac arrest is final. The force required for high-quality CPR is necessary to squeeze the heart between the sternum and the spine, an action that cannot be compromised.
Lay rescuers should not hesitate or reduce the force of their compressions. The priority remains to push hard and fast until professional medical help arrives. Taking action offers the only chance of survival, and the potential for a minor injury should not deter a rescuer.