Sixty-six-year-old, Mr Ashok Katkade would have never expected that his ordeal for next 2 months at Apollo hospitals, Nashik would become an example of team approach for management of critically ill cardiac patient. His visit to the emergency department was in a very unstable condition. Cardiologist Dr Sudhir Shetkar said," The patient had presented to us with extremely low blood pressure with excess fluid in his lungs, impairing oxygenation, a condition known as cardiogenic shock with acute pulmonary edema". His cardiac function had reduced to mere 30% due to a recent heart attack and he also had severe kidney dysfunction with highly uncontrolled diabetes. He required mechanical ventilation for next 21 days, during which his kidney function, heart function, Lung infection and diabetes were managed by a team of critical care physicians, chest physician and nephrologists, led by Cardiologist Dr Shetkar.
After stabilization over 21 days he underwent a coronary angiography which showed critical multiple blockages, for which bypass surgery was the only option. Senior cardiac surgeon Dr. Abhaysingh Walia, Cardiologist Dr Sudhir Shetkar and Cardiac anaesthetist Dr. Bhupesh Parate discussed the scenario with patient and relatives.
Normally in bypass surgeries, a patient is completely made unconscious and put on ventilator, but this patient having very poor lung, kidney and heart condition was at very high risk of death during surgery with such anaesthesia. Hence it was collectively decided to perform an awake bypass surgery in which patient is not made unconscious and is not put on ventilator machine. The cardiac anaesthetist gave the patient a special type of anaesthesia called as epidural anaesthesia, in which the patient doesn't feel pain but is still conscious. He was then successfully operated upon by cardiac surgeon.
This case is peculiar in its criticality of disease and good team approach, in managing a seriously ill patient, who because of his multiple ailments would have been lost. It also reinstates the fact that outcome of such patients is really much better when a complete heart team consisting of cardiologist, cardiac surgeon and cardiac anaesthetist take collective decision rather than any one dictating the calls. This Heart team approach is routinely recommended by most international heart societies for management of critical cardiac patients with extensive coronary artery disease, however is rarely followed in our country.