Complications of external cardiac massage: report of a case of laceration of the right ventricular outflow tract.

Closed chest cardiac massage is simple and usually a safe procedure for cardiac resuscitation. However, it is not innocuous and is occasionally associated with serious and even fatal complications. A case is reported in which fracture of the upper part of the left half of the sternum occurred following midline sternotomy. The sternum was re-approximated in the usual manner by interrupted wire sutures, but the fracture was not specifically repaired, because it was thought to be adequatley stabilized by this closure. Postoperatively, the patient required closed chest cardiac massage which caused a fatal laceration of the outflow tract of the right ventricle due to penetration of the sharp edges of fractured fragments. We believe fracture of the sternum which occurs while retracting it with sternotomy retractor during open heart surgery should be deliberately repaired to avoid this serious complication.