Circ Arrest

??? can't find info on circ arrest? I'm lost. guessing you're talking about cardiac arrest? no...you can't be. If so...ACLS book?

What kind of biggie case in the morning with circ arrest? Like a aorta bilateral femoral bypass? or a femoral/popliteal bypass? or a AAA, that's a biggie!

i assume you are doing some cardiac surg... what exactly are your quesitons regarding circ arrest??

Try Hensley's A Practical Approach to Cardiac Anesthesia. Awesome book! DHCA provides a motionless, bloodless field and is sometimes used for aortic arch reconstruction or the repair of congenital defects in neonates. The pt. is cooled to 15-20 degrees. The patients head is packed in ice and some places administer steroids or thiopental. You will also need to administer Pavulon pre- arrest to ensure minimal O2 consumption. The shorter the duration of DHCA, the better. Good luck with your case, sounds exciting!

I did one of those today. The pt was cooled to 11 degrees celcius and then cpb was stopped for a little more than 20 mins. The pt is then rewarmed and then back onto cpb until the temp becomes acceptable to come off cpb. This was a pediatric pt with a TGA.

London

Wow. That sounds moderately scary.

I have done one before, when I was a junior in my very first heart. I honesly had no idea of what was going on. We ended up not doing circ arrest.

But a big case nonetheless. A renal cell CA invaded the IVC up to the R atrium and had an appendage bouncing around the RA. 13 hour surgery for evacuation of the tumor invasion. I have never had a fluid case that required me giving 15,000+ mls of various types of fluids. Gonna go see her tomorrow. I am afraid of what I'm going to find.

We do these about 1 per month. Pavulon just prior to CPB cesation, so they don't try to breath and get an air embolus. Big dose of methyl-prednisolone 10-15 mg/kg. Mannitol by perfusion, lasix 10 mg., 50 mg benadryl and 20 mg pepcid for GI protection d/t steroids. Some do give a whopping dose of pentathol but it makes it hard to get off pump and hasn't been shown to improve outcomes. Place a nasopharyngeal probe prior to heparinization, pack the head in ice. Pray if you think it helps.

We see these very rarely post op in the ICU. The patients we see are homografts with aortic root replacement. It was amazing to have the surgeon explain to us one night how he actually performs the surgery. It is always scary for us until they wake up and we know they are neuro intact. I haven't had the chance to see one in the OR yet, but I imagine it is a very intense case for anesthesia.

I went and visited with this patient today. Extubated, doing suprisingly well. All labs were acceptable, H&H were very good. UOP excellent.

This case was an extreme in fluid managemet. Imagine an average height female, 154 kg for twelve hours with an incision running from mid-lateral abdomen on the right, coming across the abdomen past midline and involving the left abdomen and also a sternotomy. Open and exposed liver and intestines for the duration of surgery.

Fluids from the case:

EBL: 4500

Urine: 800

5% albumin: 1500

NS: 10,500

Hespan: 500

PRBC: 3250 (x 12 units)

FFP: 2880

PLTS: 620

Cellsaver: 1350

I've done considerable traumas that involved more fluids than this, but this was an elective case. Have never given 20,600 of fluids before.

I don't know anything about this from an anesthesia standpoint, but as a long-time CTICU RN at a tertiary-quad care cardiovascular care center, I have cared for lots of these pts. I find it fascinating that the patient is, for all intents and purposes, DEAD. We treat is so blasely, talking nonchalantly about 'circ arrest time'..etc. This is the cutting edge of medicine, in my opinion. The history of the development of this is really fascinating.

Potentially dead....potentially alive.....

Whew.

I would love to do a study about how many of these pts have Near Death Experiences....

Debbie