[HSF] Cardiac arrest after redo CABG in a young patient

[Edward Bender]

I would bet that this was right coronary graft occlusion.  Not  
necessarily due to the anastamosis, but perhaps due to mediastinal  
compression in the very obese.  I think this sort of event demands re- 
opening the sternum as the first act after you have arrived in the  
icu.  Let the other people do closed chest CPR while you are on your  
way to the hospital.  On my cell phone, in the car, I tell the ICU  
personnel to have the re-opening tray at the bedside, open with a pair  
of gloves ready for me to put on.  I have not saved many like this,  
but I have saved some.  Especially in morbidly obese patients, open  
cardiac compression is better than closed chest compressions.  You  
also get to definitively rule out tamponade.

Ed Bender, MD


On Dec 3, 2007, at 10:41 PM, zzhoumd at pol.net wrote:

> To forum members,
>
> This weekend I was on call. One of my partners patients developed  
> cardiac arrest. He is only 57 year old had redo CABGx5 4 days ago.  
> Weight about 300LB. After 30 minutes CPR, he is still asystole.  
> Considering his young age, I placed him on ECMO. I thought about  
> BiVAD, but I just do not know if his brain will come back. Just  
> wonder if anybody will do anything different. I did not reexplore  
> him as TEE show no tampnade and he has no more conduit.
>
> Thanks!
>
> Z Zhou
> Sent via BlackBerry by AT&T
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