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

[Prasanna Simha M]

I strongly disagree. Residents can be taught. In fact I did my first
emergency open internal cardiac massage on day 3 of my cardiac residency. It
is a skill that can be learnt and can be done by any resident. It is not
rocket science


On Dec 5, 2007 2:09 AM, Michael Firstenberg <msfirst at gmail.com> wrote:

> I would beg to differ - while many of you who have been around the
> block a few times may be quick to open the chest.  We were always
> trained that unless clear tamponade, opening a chest emergently
> usually leads to more trouble - in the midst of chaos, grafts (esp
> IMAs) get pulled off, manual CPR results in RV thumb holes, critical
> pacing wire get torn.  My question to the group is, in my limited
> experience tamponade comes up quickly but not instantly - the tubes
> slow down, or even stop, the PA pressures go up, CVP goes up,
> systemic pressures go down, increasing drips doesnt work, unless a
> true disaster - like a hole in the aorta or similar, usually there is
> sometime.  While the comments about how no open heart patient should
> die without having their chest open has some merit, it should not be
> the first intervention, not in my opinion be performed lightly
> without the input of the attending (or very senior) surgeon.
>
>
> We have lost a few very obese patients and I suspect PEs (or mucus
> plugging from poor pulm mechanics) - which may be in this case.  Very
> obese, dont move around much, these patients are often chronically
> dry, etc.
>
>
> -michael
>
>
> On Dec 4, 2007, at 6:16 PM, zzhoumd at pol.net wrote:
>
> > Ed,
> >
> > I agree with you that it is probably graft related. How do you
> > access the grafts in ICU or in OR. I used to do OPCAB with flow
> > probe. When patient arrest, none of the grafts have good flow and
> > heart is so big, every graft become stretched. If you put them on
> > bypass, flow got better but when you come off bypass, flow goes
> > down again in all grafts.
> >
> > This patient did have problem came off bypass, with IABP he did OK.
> > The IABP was removed 2 days later, but SVO2 was never good. Before
> > he arrest, PA pressure was high which dose not consistent RV infarct.
> >
> > Z Zhou
> >
> >
> >
> > Z Zhou
> >
> >
> > Sent via BlackBerry by AT&T
> >
> > -----Original Message-----
> > From: Edward Bender <ebender001 at charter.net>
> >
> > Date: Tue, 4 Dec 2007 16:44:01
> > To:OpenHeart-L at lists.hsforum.com
> > Subject: Re: [HSF] Cardiac arrest after redo CABG in a young patient
> >
> >
> > 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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-- 
Prasanna Simha M