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Ann Thorac Surg 1988;46:353-355
© 1988 The Society of Thoracic Surgeons

Articles

Acute Purulent Mediastinitis and Sternal Osteomyelitis after Closed Chest Cardiopulmonary Resuscitation: A Case Report and Review of the Literature

George A. Mensah, M.D., Jeffrey P. Gold, M.D.*, Theodore Schreiber, M.D., O. Wayne Isom, M.D.

From the Division of Cardiology, Department of Medicine, and Division of Cardiothoracic Surgery, The New York Hospital, New York, NY

Accepted for publication April 18, 1988.

* Address reprint requests to Dr. Gold, Department of Cardiothoracic Surgery, New York Hospital, 525 East 68 St, New York, NY 10021.

Numerous complications have been associated with cardiopulmonary resuscitation. Acute purulent staphylococcal mediastinitis and sternal osteomyelitis are, however, unusual and do not appear to have been reported previously in association with closed chest resuscitation. Sternal fracture during chest compressions and subsequent hematogenous seeding of the resultant retrosternal hematoma with Staphylococcus aureus led to purulent mediastinitis and sternal osteomyelitis in our patient. The source of bacteremia may have been a resolving phlebitis at an intravenous catheter insertion site. Early diagnosis, aggressive surgical debridement, and antibiotic therapy were key to a successful outcome.




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