The Annals of thoracic surgery
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Case Reports
Portable cardiopulmonary bypass: resuscitation from prolonged ice-water submersion and asystole.
Accidental hypothermia associated with near-drowning and cardiac arrest has a high mortality, especially in the adult. We report the resuscitation of a 31-year-old man who suffered extended ice-water submersion, severe hypothermia (23 degrees C), and prolonged (> or = 78 minutes) cardiac asystole. A modified portable cardiopulmonary bypass system and femoral-femoral cannulation in the Emergency Department permitted the rapid institution of core rewarming, oxygenation, and controlled reperfusion, with a successful outcome. Rapid initiation of cardiopulmonary bypass outside the operating room can be an initial treatment option in this unique clinical situation.
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Mediastinal bleeding can be a problem after cardiac surgery, either as a result of coagulation derangements or technical problems. We evaluated 100 patients, treated with temporary chest packing for intractable bleeding, of 9,383 undergoing open heart operations during a 10-year period. Preoperatively, 60 of these patients had one or more predisposing factors for bleeding. ⋯ Sternal wound infection, generalized sepsis, and sternal dehiscence was present in 24 patients, 8 of whom died. The venue for inserting or removing the packs did not affect the incidence of infections. Our experience suggests that packing of the chest after cardiac procedures for intractable bleeding allows a reasonable patient salvage rate and complication risks.