Anesthesia Arrest [Hybrid Maze Procedure]
Case #87
A man in his 60s was seen for atrial fibrillation.
He had been on various medications for his arrhythmia, which had proven difficult to manage.
A hybrid maze procedure was recommended.
His anesthesia was managed by an anesthesiologist and a CRNA in the EP lab.
The patient suffered a respiratory arrest before the procedure began.
He was initially in PEA, but the anesthesia team quickly got ROSC.
Unfortunately he developed cardiogenic shock.
The patient was transferred to a large academic medical center.
He was placed on ECMO and a balloon pump.
He continued to decline and developed multi-organ failure.
He died 2 days after the initial respiratory arrest.
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His wife hired an attorney and filed a lawsuit against the hospital and the anesthesiologist’ medical group.
Note that the anesthesiologist herself was not named as a defendant.
The expert witness opinion is shown here:
The law firm hired a financial expert (PhD in Economics) to assess the patient’s lost earnings.
The plaintiff offered to settle with the hospital for $2,500,000 and with the anesthesiologist’s medical group for $2,500,000.
The case is still ongoing.
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MedMalReviewer Analysis:
It is interesting that the anesthesiologist was not named as a defendant in the lawsuit. The plaintiff clearly is hoping for a multi-million dollar settlement, far above the typical limits on a physician’s malpractice insurance. These larger sums are typically only possible when suing a business such as a hospital, rather than an individual person.
We have a vague indication that a CRNA was involved in the patient’s care, but the lawyer did not include any details about their participation. The plaintiff displays no interest in their role, likely because there is little possibility for financial gain.
This case provides a good opportunity to review the hybrid maze procedure. While most doctors do not need to understand all the nuances related to it, reviewing the video above helps build a strong foundation of knowledge that is useful when we see patients who have had this procedure. Most of the educational material about this procedure is 5-10 years old. I look forward to hearing feedback from this group about the contemporary use of this procedure.
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They fail to state when or why the respiratory arrest occurred so it’s hard to judge. Presumably this was done under ga/ett and so it was a failure to adequately secure the airway.
I am almost completely in the dark about the cause of the respiratory arrest. What sort of anesthetic did they use? Was this a sedation case run amok? Was the patient sedated before an anticipated general anesthetic and this happened? Airway FUBAR in planned general anesthetic? Was there a syringe swap and the patient received rocuronium rather than versed as a premed? How in the hades this happened is completely opaque and this case description is useless for education or anything else in its present form.