CVICU V-Fib & Aortic Surgery Planning
September 19, 2024
Matt went into Ventricular Fibrillation (V-Fib) at 22:14 in the CVICU. The attending surgeon and I were in the same case and were luckily stat-paged immediately. Upon arrival, the CVICU team had done a nice job of getting a potential resternotomy setup initiated. We were immediately gowned and gloved as external defibrillation was performed. 3 shocks at 275, 300 and 325 joules were provided until he went into asystole. At this point, the surgeon and I decided to re-open in the CVICU using a ‘re-look’ bilateral thoracotomy (“clamshell”). We got through the wires relatively easily and were able to get the chest open within 4 - 5 min for internal cardiac massage.
We massaged for about 12 min before we were able to achieve a Return of Spontaneous Circulation (ROSC). We looked at the heart and it was noticeably flabby and could tell that the color did not look good - very grey. It was enlarged and could tell the toll that the 6 occluded arteries has taken (in addition to the aortic aneurysms - ascending and descending) on his heart.
I provided additional manual pacing at one point as his sats dropped, but they came back up. The urology came in to look at the flesh bacteria infection that has been of great concern in the perineal region. The fear is that it will travel into the abdominal cavity. The urology team is planning an aggressive debridement operative strategy that will be performed concurrently with his:
Abdominal debulking of fecal and purulent matter;
Extraction of his failing ascending and descending aortic grafts with in-situ replacements and revascularization;
CABG x6 to relieve his occluded arteries; and,
Subtotal esophagectomy to repair the aortoesophageal fistula.
As you know, Matt agreed to donate his body (perfused with ECMO) should he expire for surgical dissection. I will be involved in overseeing the dissection process - which we expect to take 2 - 3 weeks.
There remains 2 spots open to PA Students who are interested in the surgical dissection post-mortem - these spots have filled up fast and any inquiries can be directed to me and I will get them signed up (janine@aorticsurgeryfellowship.org)
Advocate: We all agree (and Matt wanted this most) that he needs a Patient Advocate given that I will be so involved in direct patient care. We are discussing with one of the best out there and have full confidence in her surgical and advocacy experience.
