Why Heart Hugger?

Heart Hugger speeds recovery with less pain, provides wound support and reduced risk of complications.

  1. Heart Hugger is applied in the ICU just before beginning your first respiratory therapy exercises.

  2. Squeeze the handles together when you stand up, sit in the chair in your room, go to the bathroom, when walking or when your caregiver is turning you in the bed.

  3. Anytime you have to cough or sneeze squeeze the handles together (especially when using the incentive spirometer).

  4. Heart Hugger should be readjusted over your street clothes and worn at home continuing to give you the wound support you need for 4-6 weeks.

Wound Support and Pain Management

After surgery, your lungs need to expand. That is why your deep breathing exercises (Respiratory Therapy) are critical to your recovery. While in surgery the ventilator was breathing for you causing your lungs to retain the water vapor that is normally expelled when you exhale. This vapor settles in your lungs and is coughed up in the form of phlegm. Each time you cough your lungs press outward against your ribcage and sternum in all directions(percussive expansion). This puts unwanted stress on the wires holding your sternum together. This stress, if remained unsupported, can lead to pain and possibly severe sternal wound complications.

Confidence and Independence

Simply squeezing the Heart Hugger handles together whenever you cough, sneeze or make uncomfortable movements provides you with uniform encircling support for the whole chest. Heart Hugger gives you the confidence and independence to be aggressive with your Respiratory Therapy, providing you with wound support and pain relief, helping to speed your recovery.

Wound Support Following Thoracic Surgery—Complications

A. Be Proactive With Complications
B. Pulmonary Complications
C. Sternal Wound Complications
D. Economic Implications
E. Sternal Wound Stability (& the Pillow)
F. Patient Compliance & The Clinical Pathway
G. Heart Hugger™ & Complications

A. Be Proactive With Complications

Major complications following thoracic surgery fall into two categories: respiratory complications and wound infections. Especially at risk are those patients with co morbidities (e.g. diabetes, obesity, emphysema, COPD, etc.) as well as barrel-chested men, large breasted women and patients on the vent for a prolonged period.

Respiratory complications are a primary concern in the recovery of the post surgical patient. Stabilization and return to premorbid levels of respiratory function is a major determi­nant in the discharge of patients. The use of a sternum support harness provides your patients with the confidence and independence to be aggressive with respiratory therapy, keeping them on your clinical pathway. Following discharge, continuing respiratory therapy exercises are critical to full recovery.

Sternal wound infection increases length of hospitaliza­tion more consis­tently than any other major complica­tioni and significantly influences readmission.ii Treatment of sternal wound complications requires a multidisciplinary approach for effective patient care.iii Use of a sternum support harness to stabilize the sternal wound reduces both pulmonary and wound compli­cations,iv,v enhancing both quality of care and cost containment.

Providing your patients with Heart Hugger™ gives them the best possible chance at a speedy, uncomplicated recovery. Heart Hugger™ is the standard of care at more than 340 hospitals worldwide.

B. Pulmonary Complications

The most common respiratory complication is pulmo­nary collapse. During monoto­nous tidal ventilation, progressive alveolar atelectasis occurs until a deep breath is taken to apply sufficient pressure to reopen the collapsed alveoli. These deep breaths occur five to ten times hourly in normal resting adults.vi

Normal lung compliance and alveolar aeration is abolished by general anaes­thesia, by narcotic drugs, such as morphine and by the effects of the ventilator, with the result that wide­spread alveolar collapse and fluid build up is invariably present following surgery.8,vii

Deep breathing exercises with emphasis on sustained inspiration to total lung capacity has been consistently effective in inflating alveoli and preventing postopera­tive pulmonary complications.viii,ix Preoperative instruction includes the practice of proper deep breathing and coughing maneuvers.x Unfortunately, recovering thoracic surgical patients are frequently non-compliant during their respiratory therapy exercises because of pain or fear of pain.

During a recent evaluation at a very busy Heart Hospital in Northern California a Respiratory Therapist informally measured the lung volume of his patient during deep breathing exercises while using a pillow and Heart Hugger™ alternately to splint the sternal wound. The result was nothing short of astounding.

He first recorded the lung volume levels while the patient used the incentive spirometer while splinting with the pillow. He then showed the patient how to use Heart Hugger™ and again measured lung volume. He recorded an increase of 30% in lung volume immediately.

The comfort, support and pain relief Heart Hugger™ offered the patient allowed him to be more aggressive with his deep breathing.

Heart Hugger™ can help increase the lung volume of your patients, getting them back to pre-op respiratory levels quicker, keeping them on your clinical pathway.

"Over half our patients are released by the fifth post-operative day, and many by the fourth post-operative day. I believe this is due in a large part to the fact that we have a device available which allows the patient to continue aggressive coughing and deep breathing at home, with much less discomfort."
David G. Ellertson, M.D., Thoracic and Cardiovascular Surgery, Modesto CA

"I am impressed that my patients who use Heart Hugger™ all seem to have a much smoother convalescence ... Because of this speeded recovery, I am inclined to allow them to be discharged from the hospital earlier."
Michael F. Teodori, M.D., Pediatric and Adult Cardiovascular Surgery, Phoenix AZ

C. Sternal Wound Complications

Sternal wound complications fall into three categories: 1) deep subcutaneous infection, 2) sternal infection and 3) medias­tinal infection with sternal dehis­cence.xi

Mediastinitis can contribute to the development of life threatening illnesses, such as systemic sepsis, respiratory insufficiency, and renal failure. Mediastini­tis occurs as a result of sternal instability and dehiscence5 and is usually evident from six days to three weeks following surgery.xii Most patients are usually discharged by this time. Patients at risk for mediastinitis and dehiscence include: patients older than 65 years (the Medicare population), diabetes patients, older women (osteoporosis), obese patients, COPD and those subjected to prolonged postopera­tive ventilation.5,xiii,xiv

The incidence of morbidi­ty and death from sternal wound complica­tions occurs in significant numbers of patients. Upwards of 2.3% of patients may suffer these complications with an associated mortality rate of 13% to 52%.3,xv,xvi The incidence of mortality after initial discharge and up to the first postop­erative year is nearly as high as hospital mortality.3

D. Economic Implications

Return to premorbid levels of respiratory function is a major determinant in the discharge of patients. Recovering open heart patients are frequently non-compliant during their respiratory therapy exercises because of pain or fear of pain. Recent federal studiesxvii have shown that inadequately managed pain can inhibit recovery, prolong hospitalization and contribute to higher-than-necessary costs. The Wound Support and Pain Management provided by Heart Hugger™ helps keep patients on your clinical pathway.

The post discharge necessity of respiratory therapy exercises cannot be overempha­sized. The use of Heart Hugger™ gives patients the confidence and independence to continue these exercises in the unsuper­vised post discharge setting.

In addition to a high mortality rate, wound complications can be financially devastating to the hospital, particularly the Medicare and co morbid population. The cost to hospitals for complications and the resulting increased length of stay ranges from $13,453 to $109,118 per complication. (To see how much money your hospital’s heart program can save by using Heart Hugger™ click HERE).

E. Sternal Wound Stability (& the Pillow)

Aggressive coughing and deep breathing maneuvers, which frequently initiates cough­ing, are important for purging the lungs of fluid and inflating the lungs to pre­vent atelecta­sis. These maneuvers are initiated in the hospital and are a mandatory part of post discharge respiratory therapy.21 The percussive expansion associated with coughing puts extreme stress on the sternal wound. Ambulat­ing, getting into and out of bed or chairs, bowel move­ments and other normal activities also place strain on the sternotomy site. While patients experience this stress on their sternal wound as pain and the feeling that they are "coming apart," the clinical result may in fact be grave: dehiscence and mediastinal infection.

Sternal stability is crucial in preventing these severe sternal wound complica­tions. Until recently, prophylactic methods used to achieve sternal stability following a sternotomy has been available only to the extent that folded sheets, towels or a pillow could be used to "splint" the incision.12 This method, while provid­ing an inward pressure to the sternum, provides no encircling support to the rib cage and chest wall during coughing, is unavail­able to the patient when ambulating, and provides no lateral support to stabilize the sternal wound.

Without sternal support, the pain of the surgical wound is often extreme. For this reason, patients often lack the confidence to continue with respiratory therapy exercises and coughing following discharge.

There is a trend toward early discharge of open heart surgery patients.5,6,21 The risk to these patients in the unsupervised, post discharge setting is two-fold: 1) the patient may be unaware or unable to diagnose a potential sternal wound complica­tion, (success in treating sternal wound complications depends upon early recogni­tion and manage­ment15); and 2) due to pain considerations, patients often lack the confidence to continue their respiratory therapy exercises in the outpatient setting. Heart Hugger™ can help manage their pain by stabilizing and supporting their surgical wound.

F. Patient Compliance & The Clinical Pathway

Heart Hugger™ Sternum Support Harness is a U.S. FDA classified medical device that provides a clear alternative to the limited methods previously described. It is a simple harness fitting over the shoulders, with a four inch wide belt around the chest, finished with handles on either end. The belt is adjusted to center the handles over the sternal wound, the patient's hand width apart. Squeezing the handles together with one or both hands tightens the chest belt, supporting the chest wall and stabilizing the sternal wound. Complete­ly encir­cling the chest, it remains loose and passive until activated by the patient.

Patients are introduced to the device prior to surgery as a part of their preopera­tive education. Following surgery (usually upon transfer from ICU to stepdown) patients are fitted with the device over their gown. Following discharge, patients wear the device at home over their street clothes for approximately three to four weeks.6,21,22 In this unsuper­vised setting it is essential that patients be able to stabilize their sternal wound for continuing respiratory therapy exercises and other stress resulting from the resumption of normal activities.

Used in conjunction with contemporary methods of wiring the sternum and suturing tissue layers, maximal sternal wound stability is achieved. The incidence of sternal infection is reduced and sternal dehiscence is practically eliminated.5,6 Addition­ally, preoperative respiratory capacity levels are achieved sooner when the device is used in conjunction with respiratory therapy exercises.

After a short training period, patients operate the Heart Hugger™ them­selves when they feel the need to stabilize their wound. It is a turning point in the patient's perception of recovery. It returns control to the patient. If patients feel that they have some control over the situation that affects them they will perceive the situation to be less stressful, will be less threatened, and will cooperate and perform better.6, 23 Patients experience more confidence and independence, taking control of their own recovery sooner, exemplifying the true sense of cardiac rehabilita­tion and keeping them on your clinical pathway.

There is a trend toward earlier discharge of thoracic surgical patients. The potential for respiratory complications, and particularly wound complications continues well into the discharge period.3,6 Heart Hugger™ enables patients to stabilize their wound, continuing aggressive coughing and deep breathing exercises while resuming normal activities: walking, climbing stairs, getting into and out of automobiles, etc.

G. Heart Hugger™ & Complications

The use of Heart Hugger TM sternum support harness provides maximal sternal wound stability, enhancing the preventive care of recovering patients and keeping them on your clinical pathway. This is particularly important in the outpatient setting, where the incidence of, and mortality from complications is as high as in the hospital, and where immediate diagnosis and management of complica­tions is absent.

Several alternative protocols have been established to minimize the risk of dehiscence and mediastinitis due to the failure of six small wires to keep the sternum stable. They include: thicker gauged wires, double wires, the Figure 8 Wiring Method, sternal cable systems and several options for sternal locks.

With all the methods and protocols developed over the years to solve the problem of sternal instability and pulmonary complications, Heart Hugger TM remains the only product that sufficiently addresses all the potentials for both following thoracic surgery. No product can eliminate all of the risks from surgery. When it comes to wound support and pain management, Heart Hugger TM does it best.

“Faster return to pre-op respiratory levels. Pain management and wound support for 4-6 weeks. A superior standard of patient care and comfort."

"I have used Heart Hugger for 15 years. Don’t even think about performing Heart or Thoracic surgery without giving your patients Heart Hugger!”

- Dr. David G Ellertson, M.D.