Ti-m WORLD MEDICAL LITERATURE is filled with articles and reports of cardiac arrests in hospitalized patients, but aside from anecdotal accounts of operating room cardiac arrests associated with a particular drug or procedure, few detailed analyses of such arrests have been published. Moreover, very little information has been made available in recent years about the influence of the method of cardiac compression used by the attending physicians on the survival rate of patients whose hearts arrest in the operating room.The objective of this article is to present a study and analysis of the incidence of cardiac arrests in our surgical suites, review the methods used for cardiac compression in the management of the arrest, relate the procedures used to survival rate achieved, and finally, to suggest how the number of ultimate survivors might be increased above the current reported rate. Neither aetiological and precipitating factors, or ancillary chemotherapy and electrotherapy are included in this presentation.Cardiac arrest is defined as a sudden and unexpected arrest of the circulation. Clinical evidence for this catastrophe includes the sudden disappearance of pulse and blood pressure, and sudden absence of breathing in those patients to whom muscle relaxants have not been administered. Moribund patients suffering from severe cardiovascular collapse associated with massive trauma, massive haemorrhage, cardiogenic or septic shock, who go on to die during or immediately after operation are not considered to meet the criteria laid down for the diagnosis of cardiac arrest and have been excluded from this study. MATEnlALS AND METrlODSThis paper is based on the cases of cardiac arrest which took place in the operating room or the post-anaesthesia recovery room of the St. Boniface General Hospital during a ten year period from January 1,1965 to December 31, 1974.The St. Boniface General Hospital is a 625 bed acute general hospital, affiliated with the University of Manitoba Medical Faculty. All types of surgery are done including open-heart and major neuro-surgical procedures. It has been a long standing custom for the members of the Department of Anaesthesia to regularly review the records and retain a brief description of all deaths occurring during or within seven days of operation and anaesthesia. Similarly, all cardiac arrests which take place in the operating suite are reviewed.
Tris (hydroxymethyl) aminomethane (tromethamine or THAM) has been suggested as an effective substitute for sodium bicarbonate (NaHCO3) in the treatment of metabolic acidosis accompanying cardiac arrest. Even though several reports on its appraisal have been published, there is still no clear agreement on its therapeutic value. A double-blind study was therefore lndertaken to compare in 36 dogs the effectiveness of 0.6 M THAM, 0.3 M THAM, and NaHCO3 (0.892 mEq/ml) to correct metabolic acidosis produced during 3 minutes of cardiac fibrillation, followed by a 3-minute period of cardiac compression. The dogs were then defibrillated and observed for 45 minutes. One group of 8 dogs was treated with 0.9 percent NaCl infusion. Compared with 0.9 percent NaCl, both THAM and NaHCO3 were equally effective in correcting metabolic acidosis (p less than 0.05). Initially, 0.6 M THAM produced a more pronounced (p less than 0.05) elevation of blood pH, but this effect was not sustained during the later postdefibrillation period. There was little difference in the effect of either of these drugs on mean aortic pressure and total peripheral vascular resistance. It is concluded that adequate ventilation and effective cardiac compression are still the chief criteria on which the final outcome of cardiac resuscitation depends. Correction of metabolic acidosis is important supportive therapy, but either THAM or NaHCO3 can be used with comparatively equivalent effect.
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