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

Fri Dec 7 06:44:17 EST 2007

Unfortunately I have seen otherwise.(And I bet others have too)
Prasanna

On Dec 7, 2007 12:20 AM, <zzhoumd at pol.net> wrote:

> Prasanna,
>
> If someone has tamponade to the point has cardiac arrest, TEE should tell
> the story.
>
> Z Zhou
> Sent via BlackBerry by AT&T
>
> -----Original Message-----
> From: "Prasanna Simha M" <prasannasimha at gmail.com>
>
> Date: Thu, 6 Dec 2007 22:07:43
> To:OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] Cardiac arrest after redo CABG in a young patient
>
>
> SorryZhou, patients can develop late tamponade days to weeks later.Ask the
> coumadin adminstrators for mitral rings and they will tell you horror
> stories !!
> Prasanna
>
> On Dec 5, 2007 12:47 PM, <zzhoumd at pol.net> wrote:
>
> >
> > May be for early post op patients you know he is bleeding or
> tamponading.
> > If someone is 5 days out, and chest tube is not wet, TEE no tamponade, I
> > just think unlikely.
> >
> > May be I could have done is to open a subxyphoid window to see if any
> > clots or blood in the pericardium.
> >
> > A year ago, a patient like this arrested 5 days after mtral repair, ECHO
> > show blood around the heart, I happened to be in the ICU even she is a
> > patient of the other group. I opened the subxyphoid part of the
> incision,
> > relieved tamponade, took to the OR, she had ruptured inferior wall
> likely
> > from Cx occlusion. Never made out of OR.
> >
> > Z
> >
> >
> > Sent via BlackBerry by AT&T
> >
> > -----Original Message-----
> > From: hgrmd at aol.com
> >
> > Date: Wed, 05 Dec 2007 00:21:30
> > To:OpenHeart-L at lists.hsforum.com
> > Subject: Re: [HSF] Cardiac arrest after redo CABG in a young patient
> >
> >
> > Michael,
> > ? If the patient is obviously going to die with current intervention,
> > there is nothing to lose by opening the chest in the bed.? Yes, you can
> > screw things up even worse.? However, you will occasionally salvage
> someone
> > who was other wise going to bone it for sure.
> >
> > Hal
> >
> >
> > -----Original Message-----
> > From: Michael Firstenberg <msfirst at gmail.com>
> > To: OpenHeart-L at lists.hsforum.com
> > Sent: Tue, 4 Dec 2007 8:09 pm
> > Subject: Re: [HSF] Cardiac arrest after redo CABG in a young patient
> >
> >
> > 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?
> > >> _______________________________________________?
> > >> OpenHeart-L mailing list?
> > >>?
> > >> Send postings to:?
> > >> OpenHeart-L at lists.hsforum.com?
> > >>?
> > >> To UNSUBSCRIBE, to CHANGE email address, or to view archives:?
> > >> http://mmp.cjp.com/mailman/listinfo/openheart-l?
> > >>?
> > >> All messages transmitted by the OpenHeart-L are subject to the?
> > >> policies and?
> > >> disclaimers posted at:?
> > >> http://www.hsforum.com/listdisclaim?
> > >> -----------------------------------------?
> > >?
> > > _______________________________________________?
> > > OpenHeart-L mailing list?
> > >?
> > > Send postings to:?
> > > OpenHeart-L at lists.hsforum.com?
> > >?
> > > To UNSUBSCRIBE, to CHANGE email address, or to view archives:?
> > > http://mmp.cjp.com/mailman/listinfo/openheart-l?
> > >?
> > > All messages transmitted by the OpenHeart-L are subject to the >
> > policies and?
> > > disclaimers posted at:?
> > > http://www.hsforum.com/listdisclaim?
> > > -----------------------------------------?
> > > _______________________________________________?
> > > OpenHeart-L mailing list?
> > >?
> > > Send postings to:?
> > > OpenHeart-L at lists.hsforum.com?
> > >?
> > > To UNSUBSCRIBE, to CHANGE email address, or to view archives:?
> > > http://mmp.cjp.com/mailman/listinfo/openheart-l?
> > >?
> > > All messages transmitted by the OpenHeart-L are subject to the >
> > policies and?
> > > disclaimers posted at:?
> > > http://www.hsforum.com/listdisclaim?
> > > -----------------------------------------?
> > ?
> > _______________________________________________?
> > OpenHeart-L mailing list?
> > ?
> > Send postings to:?
> > OpenHeart-L at lists.hsforum.com?
> > ?
> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:?
> > http://mmp.cjp.com/mailman/listinfo/openheart-l?
> > ?
> > All messages transmitted by the OpenHeart-L are subject to the policies
> > anddisclaimers posted at:?
> > http://www.hsforum.com/listdisclaim?
> > -----------------------------------------?
> >
> >
> > ________________________________________________________________________
> > More new features than ever.  Check out the new AOL Mail ! -
> >
> http://o.aolcdn.com/cdn.webmail.aol.com/mailtour/aol/en-us/text.htm?ncid=aolcmp00050000000003
> > _______________________________________________
> > OpenHeart-L mailing list
> >
> > Send postings to:
> >  OpenHeart-L at lists.hsforum.com
> >
> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> > http://mmp.cjp.com/mailman/listinfo/openheart-l
> >
> > All messages transmitted by the OpenHeart-L are subject to the policies
> > and
> > disclaimers posted at:
> > http://www.hsforum.com/listdisclaim
> > -----------------------------------------
> >
> > _______________________________________________
> > OpenHeart-L mailing list
> >
> > Send postings to:
> >  OpenHeart-L at lists.hsforum.com
> >
> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> > http://mmp.cjp.com/mailman/listinfo/openheart-l
> >
> > All messages transmitted by the OpenHeart-L are subject to the policies
> > and
> > disclaimers posted at:
> > http://www.hsforum.com/listdisclaim
> > -----------------------------------------
> >
>
>
>
> --
> Prasanna Simha M
> _______________________________________________
> OpenHeart-L mailing list
>
> Send postings to:
>  OpenHeart-L at lists.hsforum.com
>
> To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> http://mmp.cjp.com/mailman/listinfo/openheart-l
>
> All messages transmitted by the OpenHeart-L are subject to the policies
> and
> disclaimers posted at:
> http://www.hsforum.com/listdisclaim
> -----------------------------------------
>
> _______________________________________________
> OpenHeart-L mailing list
>
> Send postings to:
>  OpenHeart-L at lists.hsforum.com
>
> To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> http://mmp.cjp.com/mailman/listinfo/openheart-l
>
> All messages transmitted by the OpenHeart-L are subject to the policies
> and
> disclaimers posted at:
> http://www.hsforum.com/listdisclaim
> -----------------------------------------
>

-- 
Prasanna Simha M