[HSF] emergency surgical revascularization in acute LAD stentocclusion

[Ani Anyanwu]

But surely there are anecdotal reports of survival in such settings? How about if the patient was referred to surgery rather than angioplasty and this arrest occurred just before induction, would you proceed to operate? 
 
As Ed says part of the question is how soon the patient could be moved into empty OR. When I started my training in late 1990s cath-lab angioplasty disasters - now a rare occurrence - were not uncommon and I can recall at least two patients 'massaged' to the OR who survived without a VAD. I am sure those in practice in that era all had some dramatic saves. A year before I joined my present institution there was a celebrated case which was even more hopeless than the one erdinc reported who was placed on ECMO in the cath lab and is still alive today (albiet with a heart transplant). 
 
If you see my thread from weeks back "do you believe in miracles" you will find similar experiences where patients have proven doctors wrong. Indeed, I have a transplant patient in house whose heart I massaged 2 months ago for 45 minutes and was going to stop at 40 minutes but was waiting for the fellow to get cardiologist's agreement to call off CPR  (he agreed): this patient is still alive and waiting to go to rehab. This last case - and also some cases reported in the thread -  has made me seriously question the ethics of such prognostication and also to ponder how many people may have died because doctors gave up too early.
 
It sounds hopeless, but if the facility has the ability to have patient in a functional OR within 30 minutes, and provided the arrest was witnessed and CPR promptly and optimally performed, I would want my loved one given a chance to survive (i.e CPB) in this situation. 
 
Ani



> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] emergency surgical revascularization in acute LAD stentocclusion> From: hgrmd at aol.com> Date: Thu, 20 Sep 2007 23:53:51 +0000> CC: > > That patient wouldn,t have made it with or without surgery, IMHO.> > Hal> Sent from my Verizon Wireless BlackBerry> > -----Original Message-----> From: erdinç naseri <enaseri at hotmail.com.tr>> > Date: Thu, 20 Sep 2007 21:10:01 > To:<openheart-l at lists.hsforum.com>> Subject: [HSF] emergency surgical revascularization in acute LAD stent> occlusion> > > > Dear forum members ,> 53 Y/O male with acute anteroseptal MI.> CAG:RCA occluded,CRX nl,LAD occluded from the ostium.> PCI to LAD( succesful ) and transfer to ICU.30 minutes later developes LCO followed by deep bradycardia and then cardiac arrest.This was the moment that I saw the patient and we intubated him( pulmonary edema fluid in the tube )and started CPR. 5 minutes later consultant cardiologist arrives.CPR continues but no response is observed.I recommended very strongly( real strong) to immediately take him to op. room and give him a chance by revascularizing LAD on CPB. The Cardiologist insisted on that there would be no use to operate a patienti in his condition.Patient is lost.> What would members of the forum do in that condition.> erdinc> _______________________________________________> 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> -----------------------------------------
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