Cardiac arrest after neuraxial anaesthesia is very well described. Inhibition of the sympathetic efferent system and vagal activation leading to decrease preload and severe bradycardia results in cardiac arrest. Pregnant patients undergoing spinal anaesthesia are at increased risk for vasovagal events due to aortocaval compression and higher level of spinal block. A 36-year-old pregnant woman at 39 weeks presented for an elective caesarean section. She underwent spinal anaesthesia. Immediately after, she had severe bradycardia followed by asystole cardiac arrest. She had spontaneous return of circulation. The patient was in cardiogenic shock causing pulmonary oedema and required four vasopressors to maintain her blood pressure. An Impella 2.5 percutaneous microaxial left ventricle (LV) support device was inserted to support her haemodynamics. She fully recovered and was discharged in stable condition. To the best of our knowledge, this is first case report of the use of an LV-assist device in a patient postcardiac arrest from spinal anaesthesia.
Background: Prior data has shown that radial approach has been associated with increased rate of cerebral emboli. During transition from femoral access site (historical) to a combined radial and femoral access site (contemporary) for cardiac catheterization, we hypothesize that increased manipulation of equipment would be associated with greater manipulation of the aorta and result in increased embolic events to the brain. Our study investigates whether the rate of neurologic events changed from historical to contemporary time periods. Methods: A retrospective chart review was conducted to assess all cardiac catheterization cases performed at a large tertiary care academic center from 2007-2009 (historical n = 9776) and from 2010-2011 (contemporary n = 5294). A cerebrovascular accident (CVA) is defined as a documented central neurologic deficit persisting for at least 24 hours and a transient ischemic attack (TIA) as a neurologic event with the signs and symptoms of a CVA but which goes away within a short period of time. Results: The historical group had equivalent mean age (p=0.1), percentage female patients (p=0.13), history of cerebrovascular disease (p=0.62) and hyperlipidemia (p=0.08) as compared to the contemporary group. The historical group had lower rate of diabetes (37.4% vs 41.6%, p<0.01) and hypertension (82.1% vs 84.1%, p<0.01) but higher rate of renal failure (6.1% vs 4.8%, p<0.01) as compared to contemporary group. The historical group utilized femoral access significantly more than contemporary group (99.5% vs 79.6%, p<0.001). The historical group had equivalent CVA/TIA rate as contemporary group (0.02% vs 0.09%, p=0.056). Conclusion: Our single-center, retrospective study shows that during a period of transition to the radial artery access site for cardiac catheterization does not significantly change the rate of neurologic complications.
Background: Though cardiac catheterization via the radial artery (RA) as compared to the femoral artery (FA) access site is on the rise, most centers perform less than 10% cases via RA based on the National Cardiovascular Data Registry. RA is associated with lower rates of complications; however, in smaller centers it has been reported to be underutilized in women and elderly patients. We investigate what demographic differences exist in a large RA volume center. Methods: A retrospective chart review assessed all cardiac catheterization cases performed at a large tertiary care academic center from 2010-2011 (n=5344). Access site (RA/FA) is defined as the site of successful vascular entry. Case demographics were collected. Results: The RA was utilized in one-fifth of cases. RA patients had the same percentage males and Whites as FA access (Table 1). RA patients were younger, more likely to have commercial insurance, diabetes and hypertension. FA patients had more renal failure. The mean body mass index (BMI) was higher in the RA group. This was driven by a higher likelihood of obese patients (BMI >30) undergoing RA access than FA access. Conclusion: RA access is utilized more often in patients with younger age, diabetes, hypertension and obese BMIs. FA access is used more often in renal failure patients perhaps due to concern about contrast load.
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