Cardiac arrest in the perioperative period: a consensus guideline for identification, treatment, and prevention from the European Society of Anaesthesiology and Intensive Care and the European Society for Trauma and Emergency Surgery

Abstract

INTRODUCTION Cardiac arrest in the operating room is a rare but potentially life-threatening event with mortality rates of more than 50%. Contributing factors are often known, and the event is recognised rapidly as patients are usually under full monitoring. This guideline covers the perioperative period and is complementary to the European Resuscitation Council (ERC) guidelines. MATERIAL AND METHODS The European Society of Anaesthesiology and Intensive Care and the European Society for Trauma and Emergency Surgery jointly nominated a panel of experts to develop guidelines for the recognition, treatment and prevention of cardiac arrest in the perioperative period. A literature search was conducted in MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials. All searches were restricted to publications from 1980 to 2019 inclusive and to the English, French, Italian and Spanish languages. The authors also contributed individual, independent literature searches. RESULTS This guideline contains background information and recommendation for the treatment of cardiac arrest in the operating room environment, and addresses controversial topics such as open chest cardiac massage (OCCM), resuscitative endovascular balloon occlusion (REBOA) and resuscitative thoracotomy, pericardiocentesis, needle decompression and thoracostomy. CONCLUSION Successful prevention and management of cardiac arrest during anaesthesia and surgery requires anticipation, early recognition and a clear treatment plan. The ready availability of expert staff and equipment must also be taken into consideration. Success not only depends on medical knowledge, technical skills and a well organised team using crew resource management but also on an institutional safety culture embedded in everyday practice through continuous education, training and multidisciplinary co-operation.

Advanced life support interventions during intra‐operative cardiac arrest among adults as reported to the 7th National Audit Project of the Royal College of Anaesthetists

“…While some expert groups have published consensus recommendations for the treatment of peri-operative cardiac arrest [2][3][4][5], the 2021 European Resuscitation Council guidelines include only a few sentences on the topic [6] and the 2020 American Heart Association guidelines make no reference to peri-operative cardiac arrest [7]. Patients undergoing surgical procedures are closely and continuously monitored, and causes of unexpected intra-operative cardiac arrest may be promptly reversible, particularly when detected immediately (e.g.…”

Peri-operative cardiac arrest and resuscitation

“…In PCA, there is a high likelihood of reversible cause(s) and closed chest compressions may exhibit reduced effectiveness in cases of hypovolemia, cardiac tamponade and tension pneumothorax. In such cases, open chest compressions may be considered 5,6 . However, aggressive cardiopulmonary resuscitation (CPR) does not always lead to return of spontaneous circulation (ROSC) and optimal long-term outcomes, with 55% of the survivors having poor neurological status at 90 days after ROSC 7,8 …”

“…In October 2023, the European Society of Anaesthesiology and Intensive Care (ESAIC) and the European Society of Trauma and Emergency Surgery (ESTES) published a consensus guideline for the recognition, treatment and prevention of cardiac arrest in the peri-operative period, to complement the ERC guidelines 6 . This was a strenuous effort and the authors of the ESAIC/ESTES Guidelines should be congratulated for increasing the number of PICO questions to 32, further strengthening the basis for decision making and providing a guide for future research on PCA.…”

“…those with severe hypovolemia or those experiencing coronary artery spasm while receiving adrenaline for hemodynamic support) 14 . Also, the recommendation to use resuscitative endovascular balloon occlusion (REBOA) in exsanguinating trauma patients who are in cardiac arrest or peri-arrest was based on retrospective studies that did not establish the complete picture 6 . While REBOA is effective at creating temporary control of bleeding and increasing afterload, it induces physiologic derangements and creates an abnormal physiological state in which a portion of the body undergoes profound ischaemia (and later reperfusion).…”

Comments on ‘Cardiac arrest during the perioperative period’

“…You would like to document whether your team members provided care according to the most recent guidelines on IOCA and, if this were not the case, you would like to improve the practice of your team. As a member of ESAIC you are aware that Guidelines on IOCA have recently been published in the EJA 1 but you would also like to update your literature search on IOCA.…”