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

Fri Dec 7 12:49:19 EST 2007

I have noticed it on a few non-HSF emails that I have gotten recently.

-michael

On 12/7/07, hgrmd at aol.com <hgrmd at aol.com> wrote:
>
>
> Prasanna,
> ? I don't know why these damn computers are doing this "???" crap.? I've
> also noticed on a couple of other HSF contributors.?
>
> Hal
>
> ?
>
>
> -----Original Message-----
> From: Prasanna Simha M <prasannasimha at gmail.com>
> To: OpenHeart-L at lists.hsforum.com
> Sent: Fri, 7 Dec 2007 12:56 am
> Subject: Re: [HSF] Cardiac arrest after redo CABG in a young patient
>
>
>
>
> The ??? is coming again in your messages Hal !!
>
>
> On Dec 7, 2007 6:48 AM, <hgrmd at aol.com> wrote:
>
> > Prasanna,
> > ? Agreed.
> >
> > Hal
> >
> >
> > -----Original Message-----
> > From: Prasanna Simha M <prasannasimha at gmail.com>
> > To: OpenHeart-L at lists.hsforum.com
> > Sent: Fri, 7 Dec 2007 12:44 am
> > Subject: Re: [HSF] Cardiac arrest after redo CABG in a young patient
> >
> >
> >
> > 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.Askthe
> > > 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
> > _______________________________________________
> > 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
> > -----------------------------------------
> >
> >
> > ________________________________________________________________________
> > 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
> > -----------------------------------------
> >
>
>
>
> --
> 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
> -----------------------------------------
>
>
> ________________________________________________________________________
> 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
> -----------------------------------------
>