[HSF] Pulmonary Artery Catheters !

Fri Nov 3 16:27:01 EST 2006

Tomas,
  About 15 years ago, I was doing a "routine CABG" on a man in his 80's.  When we came of CPB, he developed massive hemoptysis.  It was so bad that flexible bronchoscopy was impossible.  I opened both pleurae widely and noticed that the RLL was becoming hemorrhagic.  The anesthesiologist jammed a Fogarty balloon blindly down the ET tube.  It apparently went into the bronchus intermedius, because when the balloon was inflated, the bleeding stopped.  The RUL appeared to still be ventilated.  Using this, we kept the balloon up for about 12 hours.  Whenever it deflated during those first few hours, the bleeding would resume.  Eventually, we were able to let the balloon down and remove it.  The patient had a bad aspiration pneumonia that required intubation for about 2 weeks.  However, it eventually cleared and I remember him looking OK in the office a couple of months later.
Hal 

-----Original Message-----
From: TSalerno at med.miami.edu
To: OpenHeart-L at lists.hsforum.com
Sent: Fri, 3 Nov 2006 3:03 PM
Subject: RE: [HSF] Pulmonary Artery Catheters !

This is the Abstract on our paper:

Massive endobronchial hemorrhage due to balloon-tipped catheter rupture of a 
branch of the pulmonary artery in a fully heparinized patient undergoing 
cardiopulmonary bypass is potentially lethal. Death occurs due to asphyxiation. 
Endobronchial intubation (double-lumen endotracheal tube) appears to be a simple 
and effective method for control of the airway and tamponade of the bleeding 
site, which allows for completion of the surgical procedure until protamine 
sulphate reversal can be achieved.

Tomas

PMID: 6830370 [PubMed - indexed for MEDLINE
-----Original Message-----
From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-bounces at lists.hsforum.com] 
On Behalf Of prasannasimha
Sent: Friday, November 03, 2006 12:27 PM
To: OpenHeart-L at lists.hsforum.com
Subject: Re: [HSF] Pulmonary Artery Catheters !

Not available online. Can you send the article  to my email.
What is the summary of the paper ?
Prasanna

Salerno, Tomas wrote:
> We reported on this subject:
>
> Cervenko FW, Shelley SE, Spence DG, Charrette EJP, Salerno TA: Massive 
endobronchial hemorrhage during cardiopulmonary bypass: Treatable complication 
of bloon-tipped catheter damage to the pulmonary artery.
> Ann Thorac Surg 1983; 35: pp 326-328
>
> Tomas
>
> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-bounces at lists.hsforum.com] 
On Behalf Of Dr. Roberto Battellini
> Sent: Friday, November 03, 2006 12:01 PM
> To: OpenHeart-L at lists.hsforum.com
> Subject: AW: [HSF] Pulmonary Artery Catheters !
>
> As less as possible. We had here 2 cases in the last 5 years of perforation
> of the pulmonary arteries and terrible intrapulmonary bleeding, they finally
> died. One of them was a case of mine, 80 years old, needed right
> pneumonectomy...game over--> for Wikipedia
> Roberto
>
> -----Ursprüngliche Nachricht-----
> Von: openheart-l-bounces at lists.hsforum.com
> [mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von Nasser F.
> Abou'Seada
> Gesendet: Freitag, 3. November 2006 11:30
> An: OpenHeart-L at lists.hsforum.com
> Betreff: RE: [HSF] Pulmonary Artery Catheters !
>
> How frequently do members of the forum use PA Catheter ? 
> - Comments ??
>
> NFA
>
> HEART CATHETERS DO NOT BENEFIT PATIENTS 
>
> (Editorial: Pulmonary artery catheters)
> http://bmj.com/cgi/content/full/333/7575/930 
>
>
>
> Doctors should probably stop using pulmonary artery catheters because they
> do not benefit patients, say doctors from Australia in this week's BMJ. 
>
> The pulmonary artery catheter was invented in 1968. It enabled bedside
> monitoring in critically ill patients by measuring heart output and
> capillary pressure in the lungs and became widely used in intensive care
> units. 
>
> But reports of serious complications soon appeared and arguments for and
> against its use have continued ever since. 
>
> The most recent evaluation, commissioned by the NHS Health Technology
> Assessment (HTA) programme, found that pulmonary artery catheters do not
> benefit patients and concluded that withdrawing them from UK intensive care
> units would be cost effective. 
>
> Another recent trial in patients with acute lung injury confirmed these
> findings, while an analysis of 13 trials reported no overall effect of using
> these devices on mortality or length of hospital stay. 
>
> So what should clinicians do with all this information? 
>
> Given that the use of pulmonary artery catheters increases the risk of
> important complications, continued use of these devices is difficult to
> defend, say the authors. 
>
> The onus is now on the proponents of the pulmonary artery catheter and
> related devices to limit their use to clinical trials and to show that
> protocols based on such devices do benefit patients, they conclude.
>
>
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