[HSF] Death

[Tea Acuff]

An odd preoccupation encouraging cadiologists to find dead hearts for LVADs. This was a tour de force. You were honest in your self description of trying to make a person's last inch an inch and a half.

Since we can't strictly tell the dead from the nearly dead, I quess the recently dead is our best guess...and which is probably the most important detail that you left out.
 
You now have a live patient with presumably a dead heart. The good solutions for that are about in the  same percent chance of getting to where you are now from where you have come. If your patient had awoken with quadriplegia, would that be a good result? Are we looking for good, or just looking? I don't have any answers and I realize that somewhere under some rock is a new species, but there are a lot of things we can encourage that likely have much better solutions. 
tea


----- Original Message ----
From: Edward Bender <ebender001 at charter.net>
To: OpenHeart-L <OpenHeart-L at hsforum.com>
Sent: Sunday, March 4, 2007 6:28:01 PM
Subject: [HSF] Death


Last week I was called to the cath lab for a 59 year old male with a  
100% left main occlusion and cardiac arrest undergoing CPR. The  
cardiologist had a pacing wire in the RV triggering a balloon pump,  
giving a BP of 40/10.  I wire was passed through the LM occlusion and  
the left system became visible, with a residual 80% LM and LAD  
stenosis and TIMI 2 flow.  The RCA was dominant and patent.  Believe  
it or not, an LV gram was subsequently performed, showing that the  
inferobasal portion of the LV moved a little - the anatomic  
confirmation that there is some mechanical activity in patients  
exhibiting pulseless electrical activity (PEA or the old term EMD).

Since we are trying to encourage cardiologists to use our services  
for VAD support in MI's complicated by cardiogenic shock, I took this  
patient to the OR.  When I opened his chest, there was no BP or  
cardiac rhythm.  I estimated by looking at the time sheets that he  
was in PEA for about 30 minutes with only brief periods of CPR (less  
than 10% of the time).  To make a long story short, I placed him on  
bypass to get an LVAD in (we only have the abiomed BVS5000).  The  
blood was so desaturated and acidotic, that it took a full minute  
before I could see a color difference in the venous and arterial  
cannulae.  He was fixed and dilated in the OR, but developed reactive  
pupils 6 hours post-op.  He woke up 20 hours post-op.  He had a  
creatinine of 1.6 and good urine output.  I transferred him to a  
major midwestern university for destination therapy vs. transplant  
(its their problem now).

My question is how long do you think it is possible to successfully  
"reanimate" a human with the support of IABP triggered by the pacer  
alone?  In other words, is there enough flow generated by  
counterpulsation to sustain life (or should I say suspend death) for  
longer periods than one would think?

Ed Bender, MD

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