Management of cardiac arrest following cardiac surgery

Brand, Jonathan; McDonald, Andrew; Dunning, Joel

doi:10.1016/j.bjae.2017.11.002

Cited by 13 publications

(19 citation statements)

References 16 publications

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“…Use of the standard doses might cause further harm to the patient by its adverse effects. In hypothermia, drugs should be withheld until core temperature is less than 30 °C, and intervals of adrenaline doubled (6–10 min) if core temperature reaches 30–35 °C [12 ▪▪ ,19,49,50].…”

Section: Modifications To the Universal Advanced Life Support Approachmentioning

confidence: 99%

Cardiac arrest in special circumstances

Lott

Truhlář

2021

Current Opinion in Critical Care

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Purpose of reviewEuropean Resuscitation Council Guidelines for Cardiopulmonary Resuscitation prioritize treatments like chest compression and defibrillation, known to be highly effective for cardiac arrest from cardiac origin. This review highlights the need to modify this approach in special circumstances. Recent findingsPotentially reversible causes of cardiac arrest are clustered into four Hs and four Ts (Hypoxia, Hypovolaemia, Hyperkalaemia/other electrolyte disorders, Hypothermia, Thrombosis, Tamponade, Tension pneumothorax, Toxic agents). Point-of-care ultrasound has its role in identification of the cause and targeting treatment. Time-critical interventions may even prevent cardiac arrest if applied early. The extracorporeal CPR (eCPR) or mechanical CPR should be considered for bridging the period needed to reverse the precipitating cause(s). There is low quality of evidence available to guide the treatment in the majority of situations. Some topics (pulmonary embolism, eCPR, drowning, pregnancy and opioid toxicity) were included in recent ILCOR reviews and evidence updates but majority of recommendations is based on individual systematic reviews, scoping reviews, evidence updates and expert consensus. SummaryCardiac arrests from reversible causes happen with lower incidence. Return of spontaneous circulation and neurologically intact survival can hardly be achieved without a modified approach focusing on immediate treatment of the underlying cause(s) of cardiac arrest.

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Section: Modifications To the Universal Advanced Life Support Approachmentioning

confidence: 99%

Cardiac arrest in special circumstances

Lott

Truhlář

2021

Current Opinion in Critical Care

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“…In contrast to ALS protocols, CALS protocols prioritize pacing and defibrillation and recommend avoiding chest compressions and epinephrine for the treatment of ventricular fibrillation (VF) or ventricular tachycardia (VT). Instead, resternotomy and internal cardiac massage are indicated if cardiac tamponade is suspected, if resuscitation is predicted to, or lasts longer than 5 min 5 . The rationale for using these specific recommendations in the resuscitation of cardiac surgical patient populations relates to several reasons.…”

Section: Introductionmentioning

confidence: 99%

“…Third, resternotomy is recommended (5) because it relieves physiological thoracic compression associated with bleeding and tamponade, 13 allows for direct visualization of the chest cavity as well as (13) internal cardiac massage 14 . Finally, the use of epinephrine in the cardiac surgical patient population has been associated with rebound hypertension and the potential for detrimental effects on blood vessels that have recently been surgically repaired; for instance, damage to the suture line of the vessel as well as the graft vessel itself in a patient following coronary artery bypass graft surgery 4,5,15 …”

Section: Introductionmentioning

confidence: 99%

Nurses' roles and responsibilities in cardiac advanced life support: A single‐site eDelphi study

Team

Bloomer

Redley

2023

Nursing in Critical Care

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BackgroundNurses are often the first responders to in‐hospital cardiac arrest in postoperative cardiac surgical patients. Poor clarity about role expectations and responsibilities can hinder nurses' performance during cardiac advanced life support (CALS) procedures.AimTo seek expert consensus on nurses' roles and responsibilities in CALS for patients in postoperative cardiac surgical patients.Study designA two‐round modified eDelphi survey. Delphi items were informed by guideline literature, an audit of resuscitation records and expert interviews. Panellists, drawn from a single site of a large tertiary health service in metropolitan Melbourne, included nurses, doctors and surgeons familiar with the management of cardiac arrest in post‐operative cardiac surgical patients.ResultsThe two rounds of the modified eDelphi generated 55 responses. A consensus of >80% agreement was reached for 24 of the 41 statements in Round 2. All items related to nurses' roles and responsibilities during nurses pre‐ and post‐arrest phases reached consensus. In contrast, only 29% (n = 4/14) of items related to peri‐arrest, and 36% of those related to nurse scope of practise in CALS arrest (n = 4/11) reached consensus.ConclusionThe study's aim was only partially achieved. Findings indicate high agreement about nurses' roles and responsibilities before and immediately after a cardiac arrest, but limited clarity about nurses' roles when implementing the CALS protocol, such as resternotomy and internal cardiac massage. There is an urgent need to address uncertainty about nurses' roles and scope of practice in CALS, which is essential to the recognition of nurses' contribution to the cardiac specialty workforce.Relevance to clinical practiseUncertainty about nurses ‘roles and responsibilities when implementing the CALS protocol may hinder their performance to their full scope of practice, leading to poor patient outcomes.

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“…The incidence of cardiac arrest after cardiac surgery ranges between 0.7% to 8%, with a survival rate of approximately 50% [ 2 - 5 ]. This relatively high survival rate can be explained by a high incidence of reversible causes precipitating the arrest, such as ventricular fibrillation (VF; 25%-50%), cardiac tamponade, hypovolemia, and tension pneumothorax [ 2 , 4 - 6 ]. Notably, aside from VF, external massage is often ineffective in these cases because of reduced diastolic filling of the heart, resulting in inadequate tissue and brain perfusion [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Virtual Reality Simulation Training for Cardiopulmonary Resuscitation After Cardiac Surgery: Face and Content Validity Study

Sadeghi¹,

Peek²,

Max³

et al. 2022

JMIR Serious Games

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Background Cardiac arrest after cardiac surgery commonly has a reversible cause, where emergency resternotomy is often required for treatment, as recommended by international guidelines. We have developed a virtual reality (VR) simulation for training of cardiopulmonary resuscitation (CPR) and emergency resternotomy procedures after cardiac surgery, the Cardiopulmonary Resuscitation Virtual Reality Simulator (CPVR-sim). Two fictive clinical scenarios were used: one case of pulseless electrical activity (PEA) and a combined case of PEA and ventricular fibrillation. In this prospective study, we researched the face validity and content validity of the CPVR-sim. Objective We designed a prospective study to assess the feasibility and to establish the face and content validity of two clinical scenarios (shockable and nonshockable cardiac arrest) of the CPVR-sim partly divided into a group of novices and experts in performing CPR and emergency resternotomies in patients after cardiac surgery. Methods Clinicians (staff cardiothoracic surgeons, physicians, surgical residents, nurse practitioners, and medical students) participated in this study and performed two different scenarios, either PEA or combined PEA and ventricular fibrillation. All participants (N=41) performed a simulation and completed the questionnaire rating the simulator’s usefulness, satisfaction, ease of use, effectiveness, and immersiveness to assess face validity and content validity. Results Responses toward face validity and content validity were predominantly positive in both groups. Most participants in the PEA scenario (n=26, 87%) felt actively involved in the simulation, and 23 (77%) participants felt in charge of the situation. The participants thought it was easy to learn how to interact with the software (n=24, 80%) and thought that the software responded adequately (n=21, 70%). All 15 (100%) expert participants preferred VR training as an addition to conventional training. Moreover, 13 (87%) of the expert participants would recommend VR training to other colleagues, and 14 (93%) of the expert participants thought the CPVR-sim was a useful method to train for infrequent post–cardiac surgery emergencies requiring CPR. Additionally, 10 (91%) of the participants thought it was easy to move in the VR environment, and that the CPVR-sim responded adequately in this scenario. Conclusions We developed a proof-of-concept VR simulation for CPR training with two scenarios of a patient after cardiac surgery, which participants found was immersive and useful. By proving the face validity and content validity of the CPVR-sim, we present the first step toward a cardiothoracic surgery VR training platform.

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Management of cardiac arrest following cardiac surgery

Cited by 13 publications

References 16 publications

Cardiac arrest in special circumstances

Cardiac arrest in special circumstances

Nurses' roles and responsibilities in cardiac advanced life support: A single‐site eDelphi study

Virtual Reality Simulation Training for Cardiopulmonary Resuscitation After Cardiac Surgery: Face and Content Validity Study

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