[HSF] endocarditis

[Michael Firstenberg]

Planning on mechanical support for a bailout in a septic patient tends to be
a bad idea.  He may not get better in the time that you have the pumps in
(although we have had shortterm pumps in for 2 months), longer term devices
will get infected.  Active/uncontrolled infection is a contraindication to
long-term mechanical support (in fact we had someone in the OR for a salvage
LVAD Saturday in whom as we were about to make incision the micro lab called
about positive blood cultures - we backed out).  We recently also had an
endocarditis case come out on ECMO/VADs for a week or two - bad EF to start,
but after a lot of work he got better.  The key is A LOT of ICU care with an
experienced team.  The other problem is, what is the next step after
mechanical support?  Will this patient ever be a transplant candidate by you
or anyone else?  I would do whatever I could to get him out of the OR
without mechanical support even if that means lots of Levo, Dobutamine, Epi
(some people love milrinone - but if he is always vasodilated as septic
patients tend to be, then you will never get his pressure up), inhailed
nitric.......but if the heart is dead and that is your only option, then
like I keep saying - was it over when the Germans bombed Pearl Harbor?

I think you may be amazed at how much a young heart will tolerate.


On 3/10/08, Hgrmd at aol.com <Hgrmd at aol.com> wrote:
>
> Gustavo,
> I sincerely hope I'm wrong about your patient.  Good  luck.
>
> Hal
>
>
>
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