Open chest cardiac massage during abdominal surgery —A case report—

Abstract

We report a case of successful resuscitation with open chest cardiac massage for intraoperative cardiac arrest during abdominal surgery. A 66-year-old man without ischemic disease was scheduled for total gastrectomy under general anesthesia supplemented with epidural anesthesia. During gastric lymph node resection, vagal reflex and transient ventricular tachycardia followed by ST-segment elevation in electrocardiographic Lead II were occurred. After thirty minutes, ventricular fibrillation developed suddenly. Since sinus rhythm was not restored even with repeated defibrillations and drug resuscitations, we started closed chest cardiac massage. However, the massage couldn't keep his blood perssure and endtidal carbon dioxide tension (ET_CO2) enough, we performed open chest cardiac massage via the incision of diaphragm. During one hour of open chest cardiac massage, ET_CO2 was elevated and maintained at about 20 mmHg. Sinus rhythm was restored with defibrillation following the administration of nitroglycerin and diltiazem. Postoperative angiographic examination of coronary vessels showed no atherosclerotic obstructions, but showed ergonovine-induced vasospasm which was reversed with intracoronary nitroglycerin infusion. The patient discharged from hospital without any neurological deficit. This case demonstrated the importance to perform open chest cardiac massage immediately unless we could keep ET_CO2 enough during resuscitation in laparotomy.