My mother suffered a cardiac arrest due to loss of airway after extubation following open heart surgery. The nurses noted the loss of airway and were bagging her before she coded. She was not "down" more than 2-3 minutes. All systems returned qucikly. Doctors expected her to clear because they did not think there should be anoxic damage as she was not down very long and had been getting respiratory support. She was kept sedated for 3 1/2 weeks to allow her to recover from surgery and because she would fight the respirator. It has now been several weeks and although she opons her eyes and follows commands to stick her tongue out no further neurological progress has occurred. She is still oa sedative, Kloponin. She has had three CTs, including a contrast, all of which were normal. EEG was slowed, but she was no ativan and had a fever at the time. Anyone have any clues or ideas? Thank you.
Neurological complications are a major and probably the most important cause of serious morbidity after open heart surgery. A commonly quoted frequency of major neurological complications is 3-5%. The numbers are higher in the elderly, in individuals with prior stroke or neurological disease (e.g. dementia), and in individuals undergoing valvular surgery (as against CABG alone). The frequency of minor neurological complications (essentially a minor temporary cognitive deficit) is much higher; the majority of older patients suffer disturbances of memory and concentration for several weeks post-operatively. The cause of neurological complications after heart surgery is believed to be related to release of air bubbles and clots into the circulation when the heart and major vessels are being worked upon. Despite numerous advances in technique, such occurence is essentially not preventable to this date.
Major neurological complications can be divided into (i) focal ones (such as stroke or seizure) and (ii) encephalopathy or non-focal ones (failure to wake up, confusional state or agitation). The latter type is more frequent. Associated problems such as infection, sedation, metabolic disturbance, and circulatory disturbance can worsen and perpetuate the encephalopathy. It is not unusual for patients to take several weeks to recover from encephalopathy, and recovery may only be incomplete (i.e. they might be left with some permanent cognitive disturbance).
I hope this answers your question.
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