Role and Prognosis of Extracorporeal Life Support in Patients Who Develop Cardiac Arrest during or after Office-Based Cosmetic Surgery

Background@#Cardiac arrest during or after office-based cosmetic surgery is rare, and little is known about its prognosis. We assessed the clinical outcomes of patients who developed cardiac arrest during or after cosmetic surgery at office-based clinics. @*Methods@#Between May 2009 and May 2016, 32 patients who developed cardiac arrest during or after treatment at cosmetic surgery clinics were consecutively enrolled. We compared clinical outcomes, including complications, between survivors (n=19) and non-survivors (n=13) and attempted to determine the prognostic factors of mortality. @*Results@#All 32 of the patients were female, with a mean age of 30.40±11.87 years. Of the 32 patients, 13 (41%) died. Extracorporeal life support (ECLS) was applied in a greater percentage of non-survivors than survivors (92.3% vs. 47.4%, respectively; p=0.009). The mean duration of in-hospital cardiopulmonary resuscitation (CPR) was longer for the non-survivors than the survivors (31.55±33 minutes vs. 7.59±9.07 minutes, respectively; p=0.01).The mean Acute Physiology and Chronic Health Evaluation score was also higher among non-survivors than survivors (23.85±6.68 vs. 16.79±7.44, respectively; p=0.01). No predictor of death was identified in the patients for whom ECLS was applied. Of the 19 survivors, 10 (52.6%) had hypoxic brain damage, and 1 (5.3%) had permanent lower leg ischemia.Logistic regression analyses revealed that the estimated glomerular filtration rate was a predictor of mortality. @*Conclusion@#Patients who developed cardiac arrest during or after cosmetic surgery at office-based clinics experienced poor prognoses, even though ECLS was applied in most cases. The survivors suffered serious complications. Careful monitoring of subjects and active CPR (when necessary) in cosmetic surgery clinics may be essential.

Retrograde Pulmonary Perfusion in Surgical Embolectomy for Massive Pulmonary Embolism

Mortality rate for pulmonary embolectomy in critically ill patients still ranges from 30% to 45%. The causes of death in these patients are persistent pulmonary hypertension, pulmonary edema, and massive pulmonary hemorrhage. Residual thrombus and air trapping in peripheral pulmonary artery during pulmonary embolectomy can cause intractable right heart failure and persistent pulmonary hypertension. We report a successful extraction of residual thrombus and air bubbles during pulmonary embolectomy by retrograde pulmonary perfusion. Use of this technique could decrease morbidity and mortality from persistent right heart failure after pulmonary embolectomy in critically ill patients.

Delayed Surgery for Aortic Dissection after Intravenous Thrombolysis in Acute Ischemic Stroke

We report a case of aortic dissection masquerading as acute ischemic stroke followed by intravenous thrombolysis. A 59-year-old man presented with dizziness. After examination, the patient had a seizure with bilateral Babinski signs. Soon after identifying multiple acute infarctions in both hemispheres on diffusion-weighted brain magnetic resonance (MR) imaging, tissue plasminogen activator (t-PA) was administered. Both common carotid arteries were invisible on MR angiography, and subsequent chest computed tomography revealed an aortic dissection. The emergency operation was delayed for 13 hours due to t-PA administration. The patient died of massive bleeding.

Right Ventricular Rupture Caused by Prolonged Cardiopulmonary Resuscitation after Sudden Cardiac Arrest / 대한내과학회지

A 46-year-old male arrived at the emergency department with acute dyspnea. On the way to the hospital, heart massage was performed in the ambulance due to asystole on electrocardiography. After 2 hr of resuscitation, sinus rhythm was restored. Extracorporeal life support and an intra-aortic balloon pump were applied due to cardiogenic shock, but the patient showed sustained hypotension. Echocardiography showed moderate pericardial effusion with physiological evidence of cardiac tamponade; emergency pericardiocentesis was performed, which produced bloody pericardial fluid. An explorative sternotomy revealed a massive hematoma in the mediastinum and right ventricular (RV) free wall rupture. After primary repair, echocardiography showed improved left ventricular systolic function and the patient was stable clinically. This case presents RV free wall rupture as an unusual complication of prolonged heart massage. Heart rupture should be considered in hemodynamically unstable patients after prolonged heart massage.

Infected Aneurysm of the Abdominal Aorta due to Streptococcus pneumoniae / 대한내과학회지

Streptococcus pneumoniae (S. pneumoniae), a bacterium that is part of the normal flora of the upper respiratory tract, can cause pneumonia, bacteremia, otitis media, and meningitis. There are few reports of infected abdominal aortic aneurysms due to S. pneumoniae, especially in Korea. We here present a 53-year-old male with an infected abdominal aortic aneurysm caused by S. pneumoniae. This patient had no previous history of atherosclerosis or infection of other organs such as the lungs, heart, or bones. He underwent resection of the abdominal aorta and iliac artery as well as bypass surgery, with maintenance of peri-operative intravenous antibiotics for 6 weeks. He has shown favorable outcomes after a 3-month follow-up.

Atypical Coronary Occlusion in a Patient with ST-Elevation Myocardial Infarction Caused by a Masked Aortic Dissection / 대한내과학회지

ST-elevation myocardial infarction (STEMI) caused by an acute aortic dissection is relatively rare. A diagnosis of dissection can be missed and the situation can become complicated. We report a patient who presented with acute aortic dissection responsible for STEMI related to a dissecting flap into the right coronary artery. This case emphasizes the need for careful assessment of the aorta in cases of atypical coronary occlusion in patients with STEMI without evidence of atherosclerosis in non-culprit coronary segments. The patient was discharged 7 days after primary percutaneous intervention for STEMI. However, she revisited the emergency department for recurrent chest pain and aortic dissection and was diagnosed and managed successfully with surgery.

Atypical Coronary Occlusion in a Patient with ST-Elevation Myocardial Infarction Caused by a Masked Aortic Dissection / 대한내과학회지

ST-elevation myocardial infarction (STEMI) caused by an acute aortic dissection is relatively rare. A diagnosis of dissection can be missed and the situation can become complicated. We report a patient who presented with acute aortic dissection responsible for STEMI related to a dissecting flap into the right coronary artery. This case emphasizes the need for careful assessment of the aorta in cases of atypical coronary occlusion in patients with STEMI without evidence of atherosclerosis in non-culprit coronary segments. The patient was discharged 7 days after primary percutaneous intervention for STEMI. However, she revisited the emergency department for recurrent chest pain and aortic dissection and was diagnosed and managed successfully with surgery.

Extracorporeal Life Support After Prolonged Resuscitation for In-Hospital Cardiac Arrest due to Refractory Ventricular Fibrillation: Two Cases Resulting in a Full Recovery

Extracorporeal life support (ECLS) has well demonstrated its efficacy in treating in-hospital cardiac arrest and is being used for broader indications. However, ECLS after prolonged cardiopulmonary resuscitation (CPR) has been traditionally contraindicated and is now challenging. Here, we introduce two cases of successful ECLS after prolonged CPR, resulting in a immediate and full recovery. Both these acute ST elevation myocardial infarction patients waiting for primary percutaneous coronary intervention (PCI) suddenly collapsed due to ventricular fibrillation (VF), which was refractory to conventional treatment. After 2 hours of conventional CPR, the ECLS had been implemented and primary PCI could be performed. Subsequent to successful revascularization, the VF was stopped with a single electric shock. In our second case, normal sinus rhythm was spontaneously restored after ECLS implementation, which was completed after 45 minutes of conventional resuscitation. Both patients made a full neurological recovery on the day of the event and were discharged with only minor complications.

Acute Diffuse Phlegmonous Esophagogastritis: A Case Report

Acute phlegmonous infection of the gastrointestinal tract is characterized by purulent inflammation of the submucosa and muscular layer with sparing of the mucosa. The authors report a rare case of acute diffuse phlegmonous esophagogastritis, which was well diagnosed based on the typical chest computed tomographic (CT) findings and was successfully treated. A 48-yr-old man presented with left chest pain and dyspnea for three days. Chest radiograph on admission showed mediastinal widening and bilateral pleural effusion. The patient became febrile and the amount of left pleural effusion is increased on follow-up chest radiograph. Left closed thoracostomy was performed with pus drainage. A CT diagnosis of acute phlegmonous esophagogastritis was suggested and a surgery was decided due to worsening of clinical condition of the patient and radiologic findings. Esophageal myotomies were performed and the submucosal layer was filled with thick, cheesy materials. The patient was successfully discharged with no postoperative complication.

Vacuum-assisted Closure for the Treatment of Lymphorrhea Following Surgery of the Femoral Artery / 대한흉부외과학회지

Lymphorrhea is a common complication after inguinal dissection for exposure of the femoral artery. Injury of the lymphatics occurs frequently because they are anatomically close to blood vessels. Uncontrolled lymph drainage increases postoperative morbidity, and wound infection may follow. Despite current treatment options, lymphorrhea after inguinal dissection is still difficult to manage and results in a prolonged hospital stay. A vacuum-assisted closure device was used in a 72-year-old woman who had lymphorrhea after vascular surgery by groin incision. Vacuum-assisted control for lymphorrhea resulted in earlier closure of the wound and reduced the length of hospital stay.