The Republic of the Philippines.
Heart Surgery in the PI: The Republic of the Philippines
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My Pump Support Drama
By Weng Puno-Baldeo
it was just a regular day in the o.r. after a vsd case the team dismantled the hlm, charged all the supplies used and preparing a standby set for the pda adult case. not long after when my colleague shouted “bypass”!. we literally jumped off from our seats and ran to the adjacent operating room. since we are 4 in our team. i took charge in assembling the arterial filter (we are using sorin dideco evo), my partner,vice, took charge of the reservoir/oxygenator, o.r nurses offered to serve the table lines. one of our perf tech took charge of the cannulas. it was a chaos! everybody was asking for something from someone.
i was running to our sterile room back to the operating room several times as our surgeons keeps on asking smaller cannulas for their femoral cannulation. finally they settled to a french 14 aortic cannula and 24/29 femoral cann….circuits primed, heparinized and recirculated. we are ready for bypass. everybody was starting to calm down. a few minutes later, we are on pump. the tension level decreases. initial hct showed 12%! what am i going to do?!? blood transfusion is a no no in her religion and we have to respect that. we decided to hemoconcentrate the patient by filtering, hoping we could bring the hct a little bit higher. fifteen minutes after the initiation, i was instructed to go off bypass temprorarily…. and we did that three times in order for our surgeons to have good visualization of field. still, they can’t transect the pda.
they advised us to prepare because we might go on circulatory arrest. i was kind of a shock coz it will be my first time if ever they will push thru with the procedure. i was trying to recall the things i learned on circulatory arrest and kinda panic and doubted myself if i could do it. our surgeon scrubbed out went outside to talk to the patient’s family. when he came back, he was given a go signal to use the cellsaver. we gave neuroprotector and steroid as our surgeons continued operate with shed blood going to the cellsaver for processing. we were able wean the pt from bypass after 1 hr and 40 mins of pump run. we processed almost all the blood in the circuitry to help bring the pt’s hct to normal level. the pt was monitored closely in the recovery room and was extubated the morning after.
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