Establish an emergency ECMO at the emergency room
On the afternoon of April 9, Cho Ray Hospital organized a sharing session of information about setting up an emergency ECMO at the emergency room to save the life of a patient with cardiac arrest due to acute myocardial infarction, related to the case of People's Artist Thanh Tuan.
Doctor Tran Thanh Linh - Head of the Intensive Care Unit (ICU) of Cho Ray Hospital - said that 1 day before being hospitalized, People's Artist Thanh Tuan (75 years old, real name Nguyen Thanh Liem) had symptoms such as chest pain and increasing difficulty breathing. Immediately afterwards, the family called for emergency care to take the artist to the hospital within 15-20 minutes.
The patient had a history of coronary artery stenosis and local anemia. The patient was admitted to the Emergency Department on the evening of March 25 in a coma and cardiac arrest.
The hospital turned on a red alert, urgent consultation, and a preliminary diagnosis of acute myocardial infarction. The patient was transferred to the Emergency Resuscitation Department after being in a deep coma, with low blood pressure, requiring maintenance of blood pressure medication, arrhythmia... The patient was treated for brain-protective hypothermia, and consulted with interdisciplinary departments.
Doctors have established an emergency ECMO system combined with coronary intervention right in the heart opening room. The coronary scanning results also discovered that the artist's blood vessels were very heavily limped, 90% narrowing the arteries.
The team drilled and cut the limestone plaque using a Rotablator, passed the ball, placed 3 stents for the patient and a ECMO process to protect the brain. The surgery lasted 2 hours.
Currently, People's Artist Thanh Tuan can eat and drink on his own, his vital signs are stable, his heart function has improved by 40%, and other organs have almost completely recovered. It is expected that the patient can be discharged from the hospital this weekend.
The smooth coordination between specialties
At the sharing session, People's Artist Thanh Tuan expressed his gratitude to the doctors who stood side by side to save the artist from the "ost life-and-death" attack. People's Artist Thanh Tuan sang a short part of the excerpt "Finding Life".
Also at the sharing session, Dr. Truong Phi Hung - Deputy Head of the Department of Cardiology, Cho Ray Hospital - said that the team had tried to save the patient's life and preserve the functions of the patient's brain. When a patient has a myocardial infarction and has complications of respiratory arrest and heart failure, the mortality rate is 80-90% if not treated promptly. This is a difficult case, requiring smooth coordination between specialties.
When the patient was hospitalized, it was immediately lowered by the body, placing ECMO to help stabilize the hemodynamics for the patient. Besides, the more difficult thing is to intervene on calcification cases with urgent time, if slow, the patient is likely to die. This situation is required to have ECMO, when the blood vessels are well opened, hope the heart muscle will recover.
Doctor Pham Thanh Viet - Deputy Director of Cho Ray Hospital - said that the doctors dared to think and dare to do. If the doctor only wanted to keep himself safe, this case would not have such a good result.
Doctors saved the patient in the mindset of no more withdrawal path, at all costs having to remove a blood vessel and place a stent. The pressure of the heart muscle is very low at this time, if the patient is taken to the operating room for open surgery, he may lose his heart muscle.
According to Dr. Ly Ich Trung - Deputy Head of the Department of Cardiovascular Intervention at Cho Ray Hospital, the technology of drilling and cutting Lamicellized Slices using Rotablator was deployed by Cho Ray Hospital in 2013. Currently, the rate of cut-off drilling cases at Cho Ray Hospital is the highest in the South. The cost of each shift is about 48 million VND, paid for entirely by health insurance.
This technique is at risk of complications, because the average drilling speed is 160,000-200,000 rpm. The drill tip is about 3mm wide and goes into the blood vessel cavity, which can cause a rupture of the blood vessel. Therefore, people who perform this technique must have a lot of experience, so it has not been widely deployed in many units.
