32160 Thoracotomy; with cardiac massage

Name of the Procedure:

Thoracotomy with Cardiac Massage

Summary

A thoracotomy with cardiac massage is a surgical procedure where an incision is made in the chest wall to access the heart directly. This procedure includes manually massaging the heart to stimulate contractions and promote circulation, often in cases of cardiac arrest or severe trauma.

Purpose

This procedure addresses critical conditions such as cardiac arrest, severe chest trauma, or specific heart conditions where immediate manual intervention is necessary to restore or maintain cardiac function. The primary goal is to restart the heart's pumping action and enhance blood flow to vital organs.

Indications

• Cardiac arrest unresponsive to external resuscitation efforts
• Severe trauma to the chest with compromised cardiac function
• Penetrating chest injuries leading to cardiac tamponade
• Intra-operative cardiac arrest during surgery

Preparation

• Patients may not have the opportunity for pre-procedure preparation due to the emergency nature of this procedure.
• If time permits, vital signs and blood tests may be quickly assessed.
• An informed consent is obtained if the situation allows.

Procedure Description

1. The patient is placed under general anesthesia if not already unconscious.
2. A large, curved incision is made in the chest wall, typically between the ribs, to expose the heart.
3. The surgeon carefully spreads the ribs to gain direct access to the heart.
4. Manual cardiac massage is performed by compressing and releasing the heart with the hands to stimulate contractions.
5. If needed, additional procedures such as control of bleeding or repair of heart structures may be performed simultaneously.
6. The chest cavity is then closed, and drains may be inserted to remove any excess fluids.

Tools and equipment used include scalpel, rib spreaders, suction devices, and surgical drains. General anesthesia is typically administered to ensure the patient remains unconscious and pain-free during the procedure.

Duration

The procedure typically lasts from 1 to 3 hours, depending on the complexity and the condition being treated.

Setting

This procedure is performed in a hospital setting, specifically in an operating room equipped for thoracic surgery.

Personnel

• Cardiothoracic Surgeon
• Surgical Assistants
• Anesthesiologist
• Surgical Nurses and Technicians
• Possible involvement of Trauma Specialists

Risks and Complications

• Infection at the incision site
• Bleeding and need for transfusions
• Rib or sternal fractures
• Damage to the heart or lungs
• Adverse reactions to anesthesia
• Respiratory complications
• Prolonged recovery time due to the invasive nature of the procedure

Benefits

The primary benefit is the potential to save the patient’s life by restoring heart function during a critical emergency. Successful cardiac massage can increase blood circulation and oxygen delivery to vital organs, buying crucial time for more definitive treatments.

Recovery

• Patients are closely monitored in an intensive care unit (ICU) immediately after the procedure.
• Pain management, including medications and possibly chest tubes, to relieve discomfort.
• Gradual return to activity as recommended by the healthcare team.
• Follow-up appointments to assess healing and cardiac function.

Alternatives

• External cardiac massage (CPR) for less severe cases or situations where thoracotomy is not possible.
• Use of Automated External Defibrillators (AEDs) as emergency interventions.
• Less invasive procedures like pericardiocentesis for specific conditions like cardiac tamponade.

Pros: Less invasive alternatives may be sufficient in some cases. Cons: These are less effective in direct stimulation and management of internal injuries compared to thoracotomy.

Patient Experience

• During the procedure, the patient will be under anesthesia and will not experience pain or awareness.
• Post-procedure, patients may experience significant pain, which is managed with analgesics.
• Physical and emotional support is crucial during the recovery period due to the invasive nature of the surgery and potential complications.