This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Zhong, T. Articles by Story, D. A. Search for Related Content PubMed PubMed Citation Articles by Zhong, T. Articles by Story, D. A.

---

LETTER TO THE EDITOR

Emergency Cardiopulmonary Bypass for Prolonged Cardiac Arrest During Hepatic Resection

Department of Anaesthesia, Sir Run Run Shaw Hospital, Hangzhou, China (Zhong, Yan) Department of Anaesthesia, Austin Hospital, Heidelberg, Victoria, Australia, david.story{at}austin.org.au (Story)

To the Editor:

We report a case of successful resuscitation using emergency percutaneous cardiopulmonary bypass (emergency bypass) during noncardiac surgery. Approximately 1 h into a hemi-hepatectomy, during portal vein dissection, there was sudden onset of hypotension and tachycardia, followed by electromechanical dissociation and subsequent ventricular fibrillation. The presumed diagnosis was gas embolism. Ventricular fibrillation was resistant to advanced cardiac life support, and so emergency bypass was established. During the first 30 min of bypass, an amiodarone infusion was started and plasma electrolyte abnormalities were corrected. The patient spontaneously reverted to a supraventricular rhythm and later to sinus rhythm. Apart from renal impairment, the patient recovered well.

The indications for emergency bypass in cardiac arrest include reversible conditions such as hypothermia, drug toxicity, and pulmonary embolism (likely in this case) (1–3). Many anesthesiologists, particularly those not routinely involved with cardiac surgery, may not think to use emergency bypass. Perioperative reports of emergency bypass in noncardiac surgery have involved cardiac arrest associated with local anesthetic toxicity (4). Survival may increase if emergency bypass is instituted within 30 min from the initial cardiac arrest (1). Because intraoperative cardiac arrests are witnessed events, in the operating room, emergency bypass can be considered in cases of cardiac arrest resistant to conventional advanced life support (1,5).

References

1. Kurusz M, Zwischenberger JB. Percutaneous cardiopulmonary bypass for cardiac emergencies. Perfusion 2002;17:269–77.[Abstract/Free Full Text]
2. Schwarz B, Mair P, Margreiter J, et al. Experience with percutaneous venoarterial cardiopulmonary bypass for emergency circulatory support. Crit Care Med 2003;31:758–64.[Web of Science][Medline]
3. Werns SW. Percutaneous extracorporeal life support: reserve for patients with reversible causes of shock and cardiac arrest. Crit Care Med 2003;31:978–80.[Web of Science][Medline]
4. Soltesz EG, van Pelt F, Byrne JG. Emergent cardiopulmonary bypass for bupivacaine cardiotoxicity. J Cardiothorac Vasc Anesth 2003;17:357–8.[Web of Science][Medline]
5. Part 6: CPR Techniques and Devices. Circulation 2005;112:IV–47–IV–50.[Web of Science]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Zhong, T. Articles by Story, D. A. Search for Related Content PubMed PubMed Citation Articles by Zhong, T. Articles by Story, D. A.