Crisis checklist (Code Red) for the management of cardiac arrest during minimally invasive thoracic surgery: case report

Abstract

Background: The management of cardiac arrest during video assisted thoracic surgery is challenging. Checklist use improve the management of operating-room crises. Case presentation: Cardiac arrest (asystole) occurred during anatomical pulmonary resection by minimally invasive surgery. Conversion to thoracotomy was decided (thoracic surgeon and anesthesiologist conjointly) to check for absence of cardiac bleeding and to start cardiac massage (4 min no-flow). After few minutes, ventricular fibrillation occurred and persisted despite shocks. Extracorporeal life support with veno-arterial extracorporeal membrane oxygenation allowed a return of spontaneous circulation (45 min low-flow). Conclusions: The patient survived without central neurologic deficit due to perfect team work process using a crisis checklist (strengthened by a comprehensive simulation program with crisis resource management).

Commentary: A checklist is nothing without simulation training and collaborative culture

“…In this regard, I suggest reading articles by Rinieri and colleagues, 4 Baste and colleagues, 5 and Dixon and colleagues. 6 The authors concur that checklists need to be implemented with other tools and describe how they successfully established at their institutions a comprehensive simulation program with crisis resource management and the introduction of multimedia support.…”