Anesthesia advanced circulatory life support

Abstract

PurposeThe constellation of advanced cardiac life support (ACLS) events, such as gas embolism, local anesthetic overdose, and spinal bradycardia, in the perioperative setting differs from events in the pre-hospital arena. As a result, modification of traditional ACLS protocols allows for more specific etiology-based resuscitation.Principal findingsPerioperative arrests are both uncommon and heterogeneous and have not been described or studied to the same extent as cardiac arrest in the community. These crises are usually witnessed, frequently anticipated, and involve a rescuer physician with knowledge of the patient’s comorbidities and coexisting anesthetic or surgically related pathophysiology. When the health care provider identifies the probable cause of arrest, the practitioner has the ability to initiate medical management rapidly.ConclusionsRecommendations for management must be predicated on expert opinion and physiological understanding rather than on the standards currently being used in the generation of ACLS protocols in the community. Adapting ACLS algorithms and considering the differential diagnoses of these perioperative events may prevent cardiac arrest.

The 10 Commandments of Resuscitation

“…If rhythm changes but does not recover, it is important to consider eight Hs and eight Ts among the possibilities for pulseless electrical activity [18]:…”

Expanding role of perioperative transesophageal echocardiography in the general anesthesia practice and residency training in the USA

“…Transesophageal echocardiography is considered a useful adjunctive diagnostic tool when perioperative cardiac arrest situations arise [25]. In a recent update on the appropriate management of the arresting patient, the early use of echocardiography is advocated if available to help establish appropriate treatment measures.…”

Update to “Anesthesia advanced circulatory life support”

“…The review, ''Anesthesia advanced circulatory life support'', by Vivek K. Moitra et al 1 in the June 2012 issue of the Journal is an excellent summary. In a section of their review regarding the treatment of gas embolism, the following paragraph requires comment: ''Promptly place patient in Trendelenburg (head down) position and rotate toward the left lateral decubitus position.…”