RESUMEN
Hypothermic cardiac arrest is a relatively uncommon presentation to United States Emergency Departments. During 1979-2002, the Centers for Disease Control reported that an average of 689 deaths per year in the US were attributed to exposure to excessive natural cold. Severe hypothermia (<30°C) confers marked depression of critical metabolic and biochemical functions, but may also provide protection to the brain and other organs while resuscitation is undertaken. For all hypothermic patients, measures designed to prevent further heat loss and begin rewarming should be instituted, but should not delay routine Advanced Cardiac and Trauma Life Support procedures. Rewarming methods include passive rewarming (insulation, removal from environment), active external rewarming (heating blankets, radiant heat, warm water immersion), and active core rewarming (warm inhalation, warmed intravenous fluids, gastrointestinal irrigation, bladder irrigation, dialysis, thoracostomy lavage, and cardiopulmonary bypass).
Asunto(s)
Puente Cardiopulmonar , Descompresión Quirúrgica , Paro Cardíaco/etiología , Paro Cardíaco/terapia , Hipotermia/complicaciones , Laparotomía , Adulto , Humanos , Hipotermia/terapia , MasculinoRESUMEN
BACKGROUND: Atrial fibrillation is the most common complication after cardiac surgery. Current medical treatment using antiarrhythmics and anticoagulants has a significant morbidity. The goal of this study was to determine if epicardial atrial defibrillation can be safely performed and return patients to sinus rhythm. METHODS: A prospective analysis of patients undergoing cardiac surgery was performed. Patients with a prior pacemaker/defibrillator, history of arrhythmia, preoperative antiarrhythmic, age greater than 85 years, history of stroke, or intraaortic balloon pump were excluded. Temporary epicardial atrial cardioversion wires were placed on the right and left atrium. Bipolar atrial and ventricular pacing wires were also placed. The wires were tested in the operating room. Patients who went into postoperative arial fibrillation were cardioverted with 3 J, 6 J, or 9 J. RESULTS: There were 45 patients enrolled. Sixteen patients (35%) went into postoperative arial fibrillation during their hospital stay. Mean time to onset of arial fibrillation was 2.6 +/- 1.4 days after surgery. Fifteen patients were successfully cardioverted to sinus rhythm on the primary cardioversion, with mean of 5.7 +/- 2.4 J. One patient was cardioverted at 6 hours after onset of arial fibrillation, at 6 J. Recurrent arial fibrillation occurred in 4 patients during their hospital stay. All 4 of these patients were cardioverted with a mean of 6.4 +/- 2.6 J. All wires were removed the day before patients were discharged. There were no complications with wire insertion or removal. There were no adverse neurologic events. The mean hospital stay was 5.1 +/- 2.2 days. All patients were in sinus rhythm at 1 month follow-up. CONCLUSIONS: The use of a temporary atrial defibrillator to resynchronize patients in postoperative arial fibrillation is safe and effective.