[Verse 1] Six hours out the pump, the clock starts tickin' slow, Wernovsky called it ninety-five, said watch the undertow, Six to eighteen hours, that's the valley of the stun, Myocardium bruised from the long bypass run, Ischaemia-reperfusion lit the inflammatory fuse, Cytokines flooding in, the muscle's paying dues, Not dead, just dazed — contractile power's on pause, Give it time and proper support, or you're facing the cause. [Chorus] Six to eighteen, that's the window, watch the slide, Stunned and swollen, septum pushing side to side, RV's a thin-walled soldier, afterload's the war, Lactate climbing, sats diving — that's the knock on the door, Preload, rhythm, pressure, PVR, and the open door, Six to eighteen, hold the line, that's what the hours are for. [Verse 2] That right ventricle's hypertrophied or stretched too thin, Either way it's fragile when the afterload kicks in, Residual gradient left behind by the knife, Or pulmonary vessels clamping, squeezing out the life, Add arrhythmia — lose that atrial kick, Tamponade's blood pooling, chest wall getting slick, Coronary injury starves the muscle of its fuel, Septum bows leftward, LV's running cruel — Filling's compromised, output's taking a dive, Interdependence means one side keeps both alive. [Chorus] Six to eighteen, that's the window, watch the slide, Stunned and swollen, septum pushing side to side, RV's a thin-walled soldier, afterload's the war, Lactate climbing, sats diving — that's the knock on the door, Preload, rhythm, pressure, PVR, and the open door, Six to eighteen, hold the line, that's what the hours are for. [Verse 3] Watch the numbers, they're confessing what you can't see, Lactate's rising — anaerobic referee, Mixed venous sat and NIRS both dropping like a stone, Tissue's starved of oxygen, cells are on their own, Oliguria's whispering, kidneys got the short stick, CVP's creeping up, right heart's backing up thick, Arterial-venous gap is widening out wide, That's the body screaming it can't keep up with the tide. [Bridge] P for preload — fill it, don't flood it, find the sweet spot, P for pacing synchrony — that AV kick, lose it not, P for pressure — vasopressin, norepi hold the line, Perfuse those right coronaries, keep the muscle fine, P for pulmonary — PVR's gotta fall, Ventilate, add the NO, let milrinone answer the call, And when the squeeze is still too tight, don't sew the sternum shut — Leave the chest open, let it breathe, that's the final cut. [Verse 4] Milrinone drops the afterload, lusitropy on tap, Inhaled nitric oxide opens up the pulmonary gap, Ventilator settings tuned to keep the vessels loose, Oxygen and alkalosis buy the right heart truce, If pressure's still collapsing and the lactate won't come down, If the chest stays tight and the output's still unfound, Call the pump — ECMO's the net beneath the wire, Rest the heart, perfuse the organs, buy the time it needs entire.
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