[HSF] Aortic dissection and CPR

[Michael Firstenberg]

I must agree with Hal on this one, not finishing what you started,  
particularly if you are concerned about wasting resources and  
potential donor organs sounds like a medical-legal path, at least  
here in the U.S., I really do not want to go down.

At least let the family think that everything was done, and if they  
dont wake up - they know you tried your best to fix their problem

-michael
On Sep 17, 2007, at 8:09 PM, hgrmd at aol.com wrote:

>
> 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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