Postoperative high-sensitivity troponin T as a predictor of sudden cardiac arrest in patients undergoing cardiac surgery

Duchnowski, Piotr; Hryniewiecki, Tomasz; Kuśmierczyk, Mariusz; Szymański, Piotr

doi:10.5603/cj.a2019.0005

“…5 In the patients undergoing valve surgery, measuring postoperative high-sensitivity troponin T is recommended because its elevation is associated with a high risk of postoperative, sudden cardiac arrest. 16 The most likely cause of cardiac arrest in this patient was migration of an embolism from the site of previous surgery. This diagnosis was made based on clinical judgement, as well as the finding of the small emboli on the doppler ultrasound.…”

Section: Discussionmentioning

confidence: 82%

Prolonged Intraoperative Cardiac Arrest in a Young Patient with Successful Precordial Thump

Ahmed

¹

,

Ejaimi

²

,

Yousif³

2020

EMJ

0

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Cardiac arrest during surgery is rare but is one of the most dreaded complications. Precordial thump (PT) had been used for a long time, but in the present day it has become obsolete. In regard to the witnessed onset of asystole, there is insufficient evidence to recommend for or against the use of the PT. This case report is of a 17-year-old male who presented to hospital with a congenital haemangioma on the right calf. He had no other significant medical conditions and was on no other medications. The patient history, clinical examination, and investigations were normal. He had undergone an operation 3 weeks previously where a section of his haemangioma was excised, and an appointment was made for excision of the remaining haemangioma. Anaesthesia induction and endotracheal intubation were smooth and uneventful. Following lifting and exsanguination of the patient’s leg by Esmarch bandage, he developed ventricular fibrillation and arrested with asystole. Cardiopulmonary resuscitation was performed, with no good response, for approximately 50 minutes. Lastly, a PT was performed, and the patient’s heart rate immediately returned. The operation was postponed. Postresuscitation care was conducted in an intensive care unit. The patient was later discharged without complications.

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“…5 In the patients undergoing valve surgery, measuring postoperative high-sensitivity troponin T is recommended because its elevation is associated with a high risk of postoperative, sudden cardiac arrest. 16 The most likely cause of cardiac arrest in this patient was migration of an embolism from the site of previous surgery. This diagnosis was made based on clinical judgement, as well as the finding of the small emboli on the doppler ultrasound.…”

Section: Discussionmentioning

confidence: 82%

Prolonged Intraoperative Cardiac Arrest in a Young Patient with Successful Precordial Thump

Ahmed

¹

,

Ejaimi

²

,

Yousif³

2020

EMJ

0

View full text Add to dashboard Cite

Cardiac arrest during surgery is rare but is one of the most dreaded complications. Precordial thump (PT) had been used for a long time, but in the present day it has become obsolete. In regard to the witnessed onset of asystole, there is insufficient evidence to recommend for or against the use of the PT. This case report is of a 17-year-old male who presented to hospital with a congenital haemangioma on the right calf. He had no other significant medical conditions and was on no other medications. The patient history, clinical examination, and investigations were normal. He had undergone an operation 3 weeks previously where a section of his haemangioma was excised, and an appointment was made for excision of the remaining haemangioma. Anaesthesia induction and endotracheal intubation were smooth and uneventful. Following lifting and exsanguination of the patient’s leg by Esmarch bandage, he developed ventricular fibrillation and arrested with asystole. Cardiopulmonary resuscitation was performed, with no good response, for approximately 50 minutes. Lastly, a PT was performed, and the patient’s heart rate immediately returned. The operation was postponed. Postresuscitation care was conducted in an intensive care unit. The patient was later discharged without complications.

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“…Duchnowski and colleagues reported that the hs TnT is a reliable predictor of cardiogenic shock necessitating mechanical circulatory support. Moreover, elevated troponin levels were associated with an increased risk of sudden cardiac arrest [ 26 , 27 ]. In contrast to our findings, Mehrpour et al [ 28 ] found no evidence of an increase in cTnI serum levels in patients with a healthy cardiovascular system following generalized CSE episodes.…”

Section: Discussionmentioning

confidence: 99%

Impact of Cardiac Injury on the Clinical Outcome of Children with Convulsive Status Epilepticus

Ibrahim

¹

,

Megahed

²

,

Salem

³

et al. 2022

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Objectives: the aim of this study was to determine the impact of cardiac injury on clinical profile, cardiac evaluation and outcome in patients hospitalized with convulsive status epilepticus (CSE). Materials and methods: this prospective observational study included 74 children with CSE. Cardiac injury was evaluated and defined using combination of cardiac troponin, electrocardiography (ECG) and echocardiography. Clinical outcome and mortality rates were compared in patients with and without cardiac injury. Results: A total of 74 patients with CSE were included in the study. Thirty-six (48.6%) patients demonstrated markers of cardiac injury. ECG changes occurred in 45.9% and echocardiographic signs of left ventricular systolic and diastolic dysfunction reported in 5.4% and 8.1%, respectively. The mean length of hospital stays and need for ICU admission were significantly higher in patients with cardiac injury compared to others. One third of patients with cardiac injury needed mechanical ventilation and this was significantly higher than patients without (p = 0.042). hypotension and/or shock developed in 25% of cardiac injury patients and most of them required inotropic support; this was significantly higher than others without markers of cardiac injury. The overall mortality in cardiac injury group was higher (13.9% vs. 2.6%); however, this difference was not statistically significant. Conclusion: Markers of cardiac injury were common and associated with poor clinical outcome and higher risk of mortality in patients with CSE, so extensive routine cardiovascular evaluation is essential in these patients.

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Postoperative high-sensitivity troponin T as a predictor of sudden cardiac arrest in patients undergoing cardiac surgery

Cited by 13 publications

References 26 publications

Prolonged Intraoperative Cardiac Arrest in a Young Patient with Successful Precordial Thump

Prolonged Intraoperative Cardiac Arrest in a Young Patient with Successful Precordial Thump

Prolonged Intraoperative Cardiac Arrest in a Young Patient with Successful Precordial Thump

Impact of Cardiac Injury on the Clinical Outcome of Children with Convulsive Status Epilepticus

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