External DC defibrillation during open heart surgery

Feasibility of open-chest cardiopulmonary resuscitation through a transdiaphragmatic approach in dogs

OBJECTIVE

To describe and evaluate the feasibility of a transdiaphragmatic (TD) approach for open-chest cardiopulmonary resuscitation (OCCPR) as an alternative to a traditional lateral thoracotomy (LT) in a canine cadaver model.

STUDY DESIGN

Randomized noninferiority ex vivo study.

ANIMALS

Fourteen canine cadavers weighing 17.4-30.2 kg.

METHODS

An LT and a TD approach to the heart were performed in each cadaver. The order of procedures as well as an assignment to specific operators were randomized before starting the study. Data recorded included the time between incision and initiation of cardiac compressions; time between initiation of the first suture placement and closure of the intrapleural space; time between initiation of the first suture placement and final skin suture; trauma to pulmonary, cardiac, hepatic and neurovascular structures; distance between the caval foramen and diaphragmatic incision; the intercostal space entered during LT; and appropriate closure.

RESULTS

The mean time between incision and initiation of cardiac compressions for the TD approach (85 ± 35 seconds) was noninferior to the LT (84 ± 28 seconds). The pleural space was closed faster after the TD approach (531 ± 276 seconds) than after the lateral approach (817 ± 294 seconds, P = .03). Total duration of closure did not differ between techniques (P = .11). There was no difference between the complication rates of each approach.

CONCLUSION

The TD approach did not prolong the procedure or increase the complication rate compared with an LT.

CLINICAL SIGNIFICANCE

This study provides evidence to support additional investigation of the TD approach for OCCPR to determine its efficacy and safety in live animals.