1. Dr.K.Alizadeh. Assistant Professor of Cardiac Surgery Dr.M.Tabari. Assistant Professor of Anesthesiology Ghaem hospital,Mashad University of Medical Science

2. Once a time, team of cardiac surgery encounters to the Coronary patients who are in cardiogenic shock and very poor hemodynamic status. Once a time, team of cardiac surgery encounters to the Coronary patients who are in cardiogenic shock and very poor hemodynamic status.

3.  But these days emergency CABG come more.....

4. We have less patients from CCU but more from Cath.Lab

5. circulation.circulation. 2006 Jul 4;114(1 Suppl):I477-85. Emergency coronary artery bypass graft surgery for acute coronary syndrome: beating heart versus conventional cardioplegic cardiac arrest strategies. Rastan AJRastan AJ, Eckenstein JI, Hentschel B, Funkat AK, Gummert JF, Doll N, Walther T, Falk V, Mohr FW.Eckenstein JIHentschel BFunkat AKGummert JFDoll NWalther TFalk VMohr FW Source Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Germany..

6. Curr Opin Cardiol.Curr Opin Cardiol. 2008 Nov;23(6):573-8. doi: 10.1097/HCO.0b013e328312c311. Off-pump coronary bypass surgery for high-risk patients: only in expert centers? Kerendi FKerendi F, Morris CD, Puskas JD.Morris CDPuskas JD Source Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia 30308, USA. Abstract PURPOSE OF REVIEW: Off-pump coronary artery bypass (OPCAB) grafting has been increasingly adopted in an effort to prevent deleterious effects of cardiopulmonary bypass, including the associated inflammatory response, global myocardial ischemia and the risks of aortic manipulation. In many studies, the greatest benefit of OPCAB has been in high-risk patients. This review will summarize the recent literature examining outcomes of OPCAB versus on-pump coronary artery bypass in high-risk subgroups, and will examine the safety of routine application of OPCAB in these patients. RECENT FINDINGS: Prospective randomized trials have shown that in comparison to on-pump coronary artery bypass, OPCAB reduces perioperative morbidity, but have failed to show a mortality benefit, owing to small sample sizes. However, numerous large retrospective series and meta-analyses have demonstrated a reduction in risk-adjusted mortality and morbidity with respect to the following outcomes: stroke, pulmonary function, renal function, atrial fibrillation, need for early reoperation, blood transfusion requirements, length of ICU and hospital stay, and hospital costs. An even greater benefit has been seen in the following high-risk patients: those with acute myocardial infarction, left ventricular dysfunction, previous history of stroke, renal insufficiency, women, elderly patients, and those undergoing reoperations. SUMMARY: Risk-adjusted outcomes are superior after OPCAB versus on-pump coronary artery bypass for mortality and numerous morbidity endpoints. This benefit is most easily demonstrated in high-risk patient populations

7. J Thorac Cardiovasc Surg.J Thorac Cardiovasc Surg. 2008 Mar;135(3):521-6. doi: 10.1016/j.jtcvs.2007.10.006. On-pump beating-heart coronary artery bypass grafting after acute myocardial infarction has lower mortality and morbidity. Miyahara KMiyahara K, Matsuura A, Takemura H, Saito S, Sawaki S, Yoshioka T, Ito H.Matsuura ATakemura HSaito SSawaki SYoshioka TIto H Source Division of Cardiovascular Surgery, Aichi Cardiovascular and Respiratory Center, Ichinomiya, Aichi, Japan. medical.miyahara@nifty.coma

8. Kyobu Geka.Kyobu Geka. 2003 Dec;56(13):1075-81; for acute coronary syndrome with preoperative intraaortic balloon pumping; comparative surgical outcome and long-term results]. [Article in Japanese] Kamohara KKamohara K, Yoshikai M, Yunoki J, Fumoto H, Itoh T, Murayama J, Hamada M.Yoshikai MYunoki JFumoto HItoh TMurayama JHamada M Source Department of Cardiovascular Surgery, Tenjin-kai Shin-Koga Hospital, Kurume, Japan.

9.  From January 2012 to January2013,about 12 coronary patients in cardiogenic shock were introduced to our service in Ghaem hospital for emergency operation. Eight patients were male and 4 were female. Mean age of male patients was 65 and for female was 72 y/o.

10.  CABG for 4 patients was started with CPR before starting the operation(3 male and 1 female)

11. Before operation if available

12.  Masui sep 2012.Jichi medical university,Japan starting percutaneus CPB ;in cath lab because all surgeons know starting CPB and canulation would be so difficult simultaneous with CPR

13.  Before operation  After starting operation on pump  At the end of operation, if failed to eliminate CPB

14.  For all 12 patients, after starting CPB,we inserted intra aortic balloon pump via femoral artery; then without cross clamping off aorta, we performed coronary grafts with beating heart on pump with stabilizer facility. IABP was active all time of operation

15.  Mortality was happened in 3 cases(one female and two male)  Approximately 25 %.  Mean ICU stay was 6.5 days.  We had one case of CVA in pattern of hemiplegia that was one of the mortalities.  25% of all cases.

16.  Our experience shows if we use IABP just after commencing CPB and using beating heart on pump technique we can get acceptable results.