Percutaneous cardiopulmonary support for the management of recurrent cardiac arrest during scoliosis correction surgery in the prone position: A case report

Effective cardiopulmonary resuscitation (CPR) is difficult for a patient undergoing surgery in the prone position. We report a successful CPR in a prone-positioned patient. This case is the first case report of successful management of recurrent cardiac arrest using percutaneous cardiopulmonary support (PCPS) during a prone-position surgery. A 18-year-old female patient with severe scoliosis underwent a deformity correction surgery. Sudden cardiac arrest occurred immediately after the insertion of a rod in the surgical field for correcting the spine alignment. The patient's position was promptly changed to the supine position, and cardiopulmonary resuscitation was performed. After the return of spontaneous circulation, the second operation was followed after three weeks. During the second operation, cardiac arrest recurrently occurred whenever the rod was inserted. Cardiopulmonary resuscitation was performed in a prone position. After returing of spontaneous circulation, patient was repositioned to a supine position and the PCPS was started. Under PCPS support, the operation was successfully completed in a prone position, and the patient was successfully weaned from PCPS.

A Comparison of Patients With Hepatocellular Carcinoma Between A Short-term (Less Than 6 months) Survival Group and A Long-term (Over 24 Months) Survival Group After Treatment with Transcatheter Arterial Chemoembolization / 대한간학회지

BACKGROUND/AIM: Although hepatocellular carcinoma(HCC) shows poor prognosis, transcatheter hepatic arterial chemoembolization(TACE) can improve survival rate in some patient groups. This study investigated the synergy effect of the different clinical indices on the survival time in patients with HCC underwent TACE. MATERIALS AND METFODS: A retrospective study of 241 patients with HCC who underwent TACE with a mixture of lipiodol, mitomycin-C and adriamycin, alone or followed by gelfoam was conducted. Three different survival groups (A, less than 6 months; B, between between 6 and 23 months; and C, over 24 months) were compared. RESULTS: Alkaline phosphatase was lowest in group C (p=0.0001). The longer the survival, the lower (p=0.027, p=0.007) the AST and AST/ALT ratio were. Albumin was higher (p=0.032), GGT and LDH were lower (p=0.003, p=0.002) in the long-term survival group. The long-term survival group revealed an absence of both ascites(p<0.002) and portal vein thrombosis(p<0.001), and lower TNM stage (P<0.0001). The single nodular type of HCC was more frequent (P<0.0001) and the size of tumor was smaller in the long-term survival group (P<0.0001). Child-Pugh class was lower in the long-term survival group (p=0.017). The higher serum albumin and elder age, the higher albumin and the lower alkaline phosphatase or alpha-fetoprotein, represented synergic effects on a long term survival. The higher albumin and the smaller size or the lower tumor stage, the higher albumin and platelet revealed similar synergy effects. Although the age or platelet is high, low albumin showed poor prognosis. CONCLUSION: Patients with small-sized single, nodular HCC in a low Child-Pugh class without evidence of ascites and portal vein thrombosis, and the higher level of serum albumin but lower levels of alpha-fetoprotein, alkaline phosphatase, GGT, and LDH, can expect a long-term survival over 24 months by the treatment of TACE. There are meaningful synergies of the different clinical variables affecting the survival times in the patients with HCC undergoing TACE.