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Tytuł oryginału: Hypothermic circulatory arrest in the management of massive pulmonary artery hemorrhage following pneumonectomy.
Autorzy: Arrowsmith Joseph E., Cook Andrew C., Birdi Inderpaul, Ritchie Andrew J.
Źródło: Case Rep. Clin. Pract. Rev. 2002: 3 (1) s.18-20, bibliogr. 11 poz.
Sygnatura GBL: 313,612

Hasła klasyfikacyjne GBL:
  • chirurgia
  • kardiologia
  • pulmonologia

    Typ dokumentu:
  • praca kazuistyczna
  • tytuł obcojęzyczny

    Wskaźnik treści:
  • ludzie
  • dorośli 45-64 r.ż.
  • płeć męska

    Streszczenie angielskie: Background: Massive hemorrhage from the divided pulmonary artery (PA) is a rare and lethal complication of pulmonary resection. In the early postoperative period the cause is invariably inadequate stump ligation, whereas in the alte postoperative period the cause is frequently pleural empyema secondary to bronchopleural fistula. Immediate resuscitation and surgical intervention are required to avert exsanguinations and death. Case report: We describe a case of life-threatening PA hemorrhage occurring within an hour of pneumonectomy. Initial resuscitation included the rapid infusion of cold blood and colloid directly into the distal aortic arch - a manoeuvre demonstrated to be neuroprotective in a canine model of exsanguination. At reoperation, repair of the torn pulmonary artery in teh face of ongoing hemorrhage proved to be impossible. Adequate surgical access could only be obtained following the institution fo cardiopulmonary bypass (CPB), adn ultimately hypothermic circulatory arrest (HCA). Despite prolonged periods of hypotension, massive transfusion of blood products and over 180 minutes of CPB, the patient rapidly made a complete recovery. Conclusion: CPB has been used successfully in a range of emergency situations including; major trauma, traumatic PA rupture, pulmonary embolism and hypothermia. To our knowledge thera appears to be only one published report of the use of CPB in the setting of PA hemorrhage during pulmonary resection. We ar not aware of any report of the successful use ofHCA in this clinical setting. In the seting of massive PA haemorrhage following pneumonectomy, theraefore, the use of CPB with HCA may be used to facilitate surgical repair with excellent clinical outcome.

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