[HSF] Aortic dissection and CPR

[hgrmd at aol.com]

Dave,

? If you aren't recommending aborting repair of the dissection while on CPB, then I guess I don't understand what you are saying.? To me, if you ever accept a patient for surgery, you should finish the job unless you think it will endanger the patient.? Other than the cost of the graft, what are you really saving?? At least in my community, you'd still get dinged for the mortality once you'd placed the patient on CPB.? Repectfully, I just don't follow your rationale.

Hal


-----Original Message-----
From: David Harris <drdharris at yahoo.co.uk>
To: OpenHeart-L at lists.hsforum.com
Sent: Mon, 17 Sep 2007 9:50 am
Subject: Re: [HSF] Aortic dissection and CPR




No, Hal, that`s not what I`m recommending.

Only for those cases where you have resuscitated for a
while, say 20 to 30 mins, and they are unresponsive,
and you revive them back from the basement by putting
them back on bypass (where some may have bailed out
already).

What then? We know that after prolonged resus, they
may already be in a vegetative state. But some may not
be. Is then worth wasting resources further by then
proceeding with hypothermic arrest and repair? I think
that`s why the mortality for dissection repair is so
high, on average.

If you already have the patient in the OR, the only
additional expense would be the disposables for a pump
run, which in S Africa is cheap. Once you have
resuscitated the patient and sorted out the immediate
cause of death, such as tamponade or RCA occlusion,
patient can be weaned off (only off the dissection
itself looks stable). If there is no brain function
later on, you could also consider for ?organ donation

Dave

--- Hgrmd at aol.com wrote:

> Dave,
>   I can't believe you are actually recommending
> aborting a dissection  repair 
> (while on CPB no less!) to see if the patient wakes
> up enough so that you  
> can take him back for Round 2.  I've never heard of
> this approach.  I  
> understand the rationale in that it would minimize
> nonsurvivors from getting a  
> definitive repair.  However, the added pain and
> wasted supplies would be  
> unjustifiable.  BTW, regardless of your last success
> with this approach, I  would be 
> surprised if there is much support for this
> algorithm.
>  
> Hal
> 
> 
> 
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Dr. David G. Harris, FCS, MMED,
Cardiothoracic Surgeon        
Suite 207                                
Kuils River Private Hospital,        
PO Box 1200, Kuils River, 7579, Cape Town, South Africa.            
Tel +27-21-9006411             
Fax +27-21-9006412      Mobile +27-83-3309587

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