Standards for Resuscitation After Cardiac Surgery

Abstract

Of the 250 000 patients who undergo major cardiac operations in the United States annually, 0.7% to 2.9% will experience a postoperative cardiac arrest. Although Advanced Cardiac Life Support (ACLS) is the standard approach to management of cardiac arrest in the United States, it has significant limitations in these patients. The European Resuscitation Council (ERC) has endorsed a new guideline specific to resuscitation after cardiac surgery that advises important, evidence-based deviations from ACLS and is under consideration in the United States. The ACLS and ERC recommendations for resuscitation of these patients are contrasted on the basis of the essential components of care. Key to this approach is the rapid elimination of reversible causes of arrest, followed by either defibrillation or pacing (as appropriate) before external cardiac compressions that can damage the sternotomy, cautious use of epinephrine owing to potential rebound hypertension, and prompt resternotomy (within 5 minutes) to promote optimal cerebral perfusion with internal massage, if prior interventions are unsuccessful. These techniques are relatively simple, reproducible, and easily mastered in Cardiac Surgical Unit–Advanced Life Support courses. Resuscitation of patients after heart surgery presents a unique opportunity to achieve high survival rates with key modifications to ACLS that warrant adoption in the United States.

Cardiac Surgery Unit Advanced Life Support Training

“…The protocols within the CSU-ALS guideline follow 3 pathways: shockable rhythm, symptomatic bradycardia, and PEA/asystole. Shockable rhythms are treated with 3 sequential shocks, CPR, and amiodarone administration while the team prepares to perform resternotomy if the patient does not respond 1,17,18,21,25 . Symptomatic bradycardia is treated with pacing using established epicardial wires, and CPR is done while the team prepares to perform resternotomy if the patient does not respond.…”

DCCN on the Web

“…Shockable rhythms are treated with 3 sequential shocks, CPR, and amiodarone administration while the team prepares to perform resternotomy if the patient does not respond. 1,17,18,21,25 Symptomatic bradycardia is treated with pacing using established epicardial wires, and CPR is done while the team prepares to perform resternotomy if the patient does not respond. In the case of PEA/asystole, the resuscitation team is instructed to perform CPR while the operators prepare to perform resternotomy.…”

“…Although there is a growing body of literature supporting the guideline as a new standard of care, very little evidence is offered as it relates to outcomes. 1,13,[16][17][18][19] This article describes one center's experience after formally introducing the guidelines as a standard practice. Survival at time of arrest and time of discharge will be compared as preintervention and postintervention data.…”

Kreislaufstillstand unter besonderen Umständen

“…Die Verwendung einer SGA soll dann in Betracht gezogen werden, wenn der Patient zuvor nicht beatmet wurde [ 496 , 504 , 505 ]. Erwägen Sie für VT/VF während des Flugs drei eskalierende Defibrillationen [ 506 ].…”