Six-Year Prospective Audit of ‘Scoop and Run’ for Chest-Reopening after Cardiac Arrest in a Cardiac Surgical Ward Setting

OBJECTIVES:

The aim of the study was to identify which cardiac surgical ward patients benefit from ‘scoop and run’ to the operating room for chest reopening.

METHODS:

In-hospital arrests in a cardiothoracic hospital were prospectively audited over a 6-year period. The following pieces of information were collected for every patient who was scooped to the operating room following cardiac arrest on the postoperative cardiac surgical wards: type of arrest, time since surgery, patient physiology before arrest, time to chest reopening, location of chest opening, surgical findings on reopening, time to cardiopulmonary bypass (if used) and patient outcomes. Exclusions: arrests in intensive care unit (ICU) and operating rooms. The primary outcome measure was survival to discharge from the hospital.

RESULTS:

There were 99 confirmed ward arrests in 97 cardiac surgical patients. The overall survival rates to discharge and at 1 year were 53.6% (52 of 97 patients) and 44.3% (43 of 97 patients), respectively. Twenty-one of the 97 (21.6%) patients underwent scoop and run to the operating room or ICU. Five of 12 daytime ‘scoop and runs’ survived to discharge, whereas none of nine survived where scoop and run was undertaken at night (P < 0.05). There was a trend towards increased survival when 'scoop and run' was undertaken following ventricular fibrillation/pulseless ventricular tachycardia arrests (P = 0.06) and in younger patients (P = 0.12) but neither achieved statistical significance. The median time out from surgery of survivors was 4 days (range 2-14 days). The median time to chest opening in survivors was 22 min. Cardiopulmonary bypass was utilized in four of five survivors. The median ICU and hospital lengths of stay were 176 h (range 34-857) and 28 days (range 13-70), respectively.

CONCLUSIONS:

The key determinant of a favourable ‘scoop and run’ outcome was whether the arrest occurred during daytime or night-time hours (P < 0.05). Despite a median time to chest opening of 22 min, all five survivors were discharged neurologically intact. The median time from surgery in these survivors was 4 days. Because of the risk of hypoxic brain damage, 'scoop and run' should be restricted to patients suffering witnessed arrests. The study has potential implications for resuscitation training and out-of-hours medical staffing in cardiothoracic hospitals.