This document discusses the roles and responsibilities of nurses and other staff during an emergency sternotomy or open chest code. It indicates that an emergency sternotomy may be performed within 2 weeks of cardiac surgery to address complications like cardiac tamponade, excessive bleeding, or refractory arrhythmias. A case study found survival was 48% if the patient was opened within 10 minutes of arrest and dropping to 12% if opened after more than 10 minutes. The roles of physicians, respiratory therapists, nurses and supplies needed are outlined, including having at least 6 nurses present with assigned roles like bedside care, team lead, medications, etc. Specialty tools for an emergency sternotomy like a sternotomy tray, internal defibrillator paddles,

1. Jennifer Kime RN BSN CCRN-CSC-CMC
Michele Dollar RN BSN CCRN-CSC-CMC CNRN
Linay Williams RN
Ed Otton RN BS BSN CCRN

2. Objectives
 Review reasons for Emergency Sternotomy/Open
Chest Code
 Discuss roles and responsibilities of OHS RN and non-
OHS RN during post open heart emergencies
 Review skills of aseptic and sterile technique
 Emergency Sternotomy specialty supplies

3. Indications
 Emergent sternotomy for a patient after cardiac
surgery is performed (usually within the first 2 weeks)
to identify and eliminate the following areas of
postoperative complications:
 Cardiac tamponade with imminent arrest
 Exploration due to excessive bleeding
 Refractory VF/VT without improvement after standard
treatments. (Provides access for open cardiac massage
and internal defibrillation)

4. Open Chest Case Study
 6 year prospective study, 79 re-openings
 48% survived if patient opened within 10 minutes, survival
rate dropped to 12% for more than 10 minute opening.
 Concluded favorable determinants:
Arrest within 24 hours of surgery
Reopening within 10 minutes of arrest
Arrest in ICU
 In this particular study, all patients reopened outside the
ICU died
2002 European Journal of Cardiothoracic Surgery, 22(3), pp. 421-425

5. Open Chest Code Roles and
Responsibilities
 Physicians
 Attending
 Fellow
 Resident
 RTs
 Nursing
*Everyone in the room should have a minimum of mask
and head cover.

6. The following people need to be
notified (usually charge nurse):
 SICU team/CT attending and fellow
 Blood bank
 OR/anesthesia (through operator during off hours)
 Family
 Chaplin

7. Nursing Roles and Responsibilities
 6 RNs present
 Bedside RN (may be only “Heart” RN in the room)
 Designated Nursing Team leader during Code. Maintains and
monitors sterile field.
 Assigns roles of nursing staff
 Medication Administration RN
 Code Cart/Defibrillator RN
 Recorder
 Runner
 Sterile RN (maybe deferred to resident or OR staff)
 Non-sterile RN to manage white drawers, and
instrument trays

8. Internal Defibrillator & Open Chest
Box

9. Open Chest Procedure
 1) Continue CPR until open chest supplies are ready, sterile
field is prepared, and surgeon is ready to perform
procedure.
 2) Assist surgeon with sterile gown and gloves. Mask, head
cover, eye protection.
 3) Remove Silverlon dressing, duraprep chest wall
 4) Setup sterile field –large drape
 5) Empty contents onto sterile field *#10 scalpel blade and
wire cutters. Suction tubing and yankauer x2. Lap sponges
and saline bowl. Sternotomy instrument tray on end table.
Maintain Sterile Field

10. Emergent Sternotomy Specialty
Tools
 Duraprep

11. Emergent Sternotomy Specialty
Tools
Two items will be taped to top of the
sternotomy tray: #10 Blade and
Wire cutters AKA Side cutters

12. Inside the Sternotomy Tray
Loose InstrumentsStringer Instruments

13. Emergent Sternotomy Specialty Tools
 Internal paddles
 2 sizes, adult and pediatric
 Hooks to defib, 5-20 joules

14. Emergency Sternotomy Video
 https://www.youtube.com/watch?feature=player_deta
ilpage&v=B5sStG4RadY