ABSTRACT
We report a case of a 13-year-old boy with a presumed neck cyst who developed sudden tracheal obstruction and out-of-hospital cardiac arrest. Cardiorespiratory collapse occurred due to an improperly diagnosed mediastinal tumor. This report serves to alert Emergency Physicians and emergency medical services personnel of the rare and rapidly progressive nature of respiratory compromise caused by a mediastinal tumor, which may have lethal consequences if not recognized and treated promptly.
Subject(s)
Airway Obstruction/etiology , Heart Arrest/etiology , Lymphoma/complications , Mediastinal Neoplasms/complications , Adolescent , Airway Obstruction/diagnostic imaging , Fatal Outcome , Humans , Lymphoma/diagnostic imaging , Male , Mediastinal Neoplasms/diagnostic imaging , Tomography, X-Ray ComputedSubject(s)
Biomedical Research , Cardiovascular Surgical Procedures/methods , Hospitals, State , Pediatrics/methods , Animals , Assisted Circulation/education , Assisted Circulation/instrumentation , Assisted Circulation/methods , Cardiopulmonary Bypass/education , Cardiopulmonary Bypass/instrumentation , Cardiopulmonary Bypass/methods , Cardiovascular Surgical Procedures/education , Cardiovascular Surgical Procedures/instrumentation , Child , Child, Preschool , Education, Medical , History, 21st Century , Hospitals, State/history , Hospitals, State/methods , Humans , Infant , Infant, Newborn , Pediatrics/education , Pediatrics/instrumentation , United StatesABSTRACT
We describe a process by which we sought to determine how the addition of intraoperative neurophysiologic monitoring (IONM) impacted the management of cardiopulmonary bypass (CPB) during pediatric cardiac surgery. While maintaining a consistent team of surgeons, anesthesiologists, nurses, and perfusionists, a multi-modal, IONM program was established consisting of Near Infrared Spectroscopy, Transcranial Doppler, and eight channel electroencephalography. A retrospective review of cases from 1 year before the institution of the IONM program was compared with data obtained from cases performed after neurophysiologic monitoring was established as a standard of care for pediatric patients on CPB. This comparative analysis of CPB management revealed a significant increase in the use of donor blood added to the CPB circuit prime as well as in the maintenance of a higher hematocrit during the bypass period after the implementation of IONM. These changes in the management of pediatric CPB correlated with recommendations of previous studies that examined postoperative neurophysiologic outcomes, suggesting that these changes were not only consistent with best practices, but that the presence of IONM data facilitated a transition to evidence-based practice.
