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

[Prasanna Simha M]

Why was the rhythm asysole  one of the points is a possible RCA graft
occlusion. at least if you had opened the chest that could have been ruled
out. You (and all of us) are now neither wiser nor have been able to
formulate a secondary plan if the same thing repeats again tomorrow. That is
also another reason to reexplore.patients do develop tamponade  upto weeks
after cardiac surgery. You yourself said that the patient was having low
mixed venous sats etc even after day 3. Something was not right and he
needed to have further monitoring.
>Prasanna

On Dec 6, 2007 10:23 PM, <zzhoumd at pol.net> wrote:

> Thanks! I have done that in the past. For immediate open heart patients,
> it make sence. For patients in post-op day 5 with no TEE evidence of
> tamponade, and the rythm is asystole, it is usually not a salvagable.
> because open chest dose not solve the problem.
>
> Z
>
> Sent via BlackBerry by AT&T
>
> -----Original Message-----
> From: "Prasanna Simha M" <prasannasimha at gmail.com>
>
> Date: Thu, 6 Dec 2007 21:54:35
> To:OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] Cardiac arrest after redo CABG in a young patient
>
>
> Rule in my ICU - one wire cutter and scalpel are kept in a sterile ETO
> pack
> at all times. That is all that is required to open the chest. Chests can
> be
> opened by any  resident and internal massage can be instituted. It doesn,t
> need a consultant to come from home to inititate it. I tell my residents
> to
> open and inititate massage and they do so well before I even come. In my
> hospital we tell our residents to open the chest if we do not get an
> effective rhythm within a few minutes and definitelyby 10 minutes. I have
> reexplored patients etc (as I am sure all of us must have done) in the
> ICU.
> Zhou, if you cannot do it in your ICU then a radical change neeeds to be
> done. If you can initiate fem fem ECMO or install a Bivad but cannot
> reeplorein your ICU (and I bet I have less resources in my set up than
> yours) your hospital needs to critically readdress this problem. Every
> cardiac surgical ICU should be able to reexplore a patient andd should in
> fact be able to place a patient on CPB also if required there).
>
> Prasanna
>
> On Dec 4, 2007 11:44 PM, Edward Bender <ebender001 at charter.net> wrote:
>
> > 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
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-- 
Prasanna Simha M