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

Thu Dec 6 19:07:44 EST 2007

Geez...
tea

----- Original Message ----
From: "zzhoumd at pol.net" <zzhoumd at pol.net>
To: OpenHeart-L at lists.hsforum.com
Sent: Thursday, December 6, 2007 8:11:46 PM
Subject: Re: [HSF] Cardiac arrest after redo CABG in a young patient

Usually due to infact. Tissue is dead. It dose not take much to rupture infarcted tisse. 

Z
Sent via BlackBerry by AT&T

-----Original Message-----
From: Tea Acuff <tacuff at swbell.net>

Date: Thu, 6 Dec 2007 17:12:01 
To:OpenHeart-L at lists.hsforum.com
Subject: Re: [HSF] Cardiac arrest after redo CABG in a young patient

That's probably because its too big.

tea

----- Original Message ----
From: "hgrmd at aol.com" <hgrmd at aol.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Thursday, December 6, 2007 5:16:40 PM
Subject: Re: [HSF] Cardiac arrest after redo CABG in a young patient

Michael,

? From what you've said, your CT surgeons could possibly use a little refresher course on open resuscitation.? As far as I know, I've never put my thumb through anyone's RV.

Hal

-----Original Message-----
From: Michael Firstenberg <msfirst at gmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Thu, 6 Dec 2007 6:00 pm
Subject: Re: [HSF] Cardiac arrest after redo CABG in a young patient

Although I do not disagree with what is being said - I vividly recall opening the chest of an elderly women post-op day 2 after an ascending/hemi-arch who arrested. We coded her for a while before I opened her chest (with the approval of the Attending over the phone) and a junior Vascular attending assisting who agreed. While it looked like tamponade the finding were not clear and probably a respiratory arrest in the retrospect - the Attending never forgave me (the patient did survive to discharge but was neurologically impaired). I felt clearly hung out to dry. I also remember watching a CT surgeon fellow put his thumb thru a friable RV - game over. Seen grafts ripped off, attempts at repairs only to make things worse.... my point is that these thing must be well controlled, organized, and orchestrated.?
?
-michael?
?
?
On Dec 6, 2007, at 4:40 PM, Prasanna Simha M wrote:?
?
> 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?
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