Well on Friday we placed a man on ECMO he had some really big issues. This morning he looked fantastic. So the Dr. decided that he was ready to come off of ECMO. We started out by weaning him down first to 3.0L/Min, then 2.0 then 1.5 then 1.0 then off of ECMO. He looked great he had great pressure and his sats were all good. THEN....... He crashed. Fortunately we were ready with a pump primed and ready to go. So on bypass we went.
We started out by putting in an RVAD (centrimag) which was a cool experience to be a part of. It is a little different. We run bypass like every other case except for a couple of important points. We don't use Cardioplegia, you don't want to arrest the heart when you are trying to assist. We came of off CPB and he looked good. THEN......you guessed it crashed on the left side. We hadn't de-primed our circuit yet (which you never do until the chest is closed) so we were ready to go right back on.
We ended up putting in an LVAD (centrimag also). It was really interesting to watch this part of the case because the RVAD was still running which made our gasses go all over the place. One second it was perfect then it was all messed up, then it went right back to being great. Last I checked at 4pm he wasn't able to oxygenate himself. Unfortunately it looks like he will be getting a Heartmate II for destination therapy.
All the time during school we talk about death so casually but today it really hit me that this man that I transported downstairs and his wife touched his hand and said, "I'll see you in a couple of hours" may not be able to talk to his wife again. It reinforced to me how serious this profession is and I must to everything that I can to be "a patient advocate" and make sure my skill set is where it needs to be to help these patients.
--Gregory Kitchen
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