Management of Intraoperative Cardiac Arrest

Kacha, Aalok K.; Hicks, Megan Henley; Mahrous, Christopher; Dalton, Allison; Ben-Jacob, Talia K.

doi:10.1016/j.anclin.2022.10.002

Cited by 2 publications

(11 citation statements)

References 63 publications

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“…If an airway is not in place, compressions should not be interrupted for the placement of a definitive airway. 18,19 If not already present, defibrillator pads should be placed on the patient. A team member should be given the role of recording and timing.…”

Section: Cardiac Arrest In the Operating Roommentioning

confidence: 99%

“…38 The majority of cases of anaphylaxis are caused by drug-induced reactions such as antibiotics, analgesics, and nondepolarizing muscle relaxants. 19 Management should involve cessation of the offending agents, establishing IV access, supplemental oxygen, and subsequent establishment of a definitive airway, fluid boluses, and administration of epinephrine. Epinephrine is essential to the management of anaphylaxis because it stabilizes the mast cells and prevents further degranulation.…”

Section: Anaphylaxismentioning

confidence: 99%

“…Pulmonary embolism (PE) is a rare but serious cause of cardiac arrest, which can cover a wide array of causes, including acute venous or arterial thromboembolism, venous gas embolism, fat embolism, or amniotic fluid embolism. 19 Studies looking at PE found a relatively low and consistent rate of PE among general surgery and most surgical subspecialties ranging from 0.3 to 1.6%, with an exception in orthopedic surgery with an incidence ranging from 0.7% to 30%. [54][55][56][57] The elevated incidence during orthopedic surgery may be driven by hip fracture repair, which carries a reported incidence of 4.3% to 24%.…”

Section: Pulmonary Embolismmentioning

confidence: 99%

“…Vasopressin is the preferred vasopressor in cardiac instability due to PE because it supports systemic pressures while not further increasing resistance in the pulmonary circulation and worsening RV afterload. 19…”

Section: Pulmonary Embolismmentioning

confidence: 99%

“…While latex allergy has historically comprised a large portion of anaphylactic reactions, this has been improved with better surveillance and a lack of routine use of latex-containing products 38 . The majority of cases of anaphylaxis are caused by drug-induced reactions such as antibiotics, analgesics, and nondepolarizing muscle relaxants 19 . Management should involve cessation of the offending agents, establishing IV access, supplemental oxygen, and subsequent establishment of a definitive airway, fluid boluses, and administration of epinephrine.…”

Section: Special Considerations During Intraoperative Arrestmentioning

confidence: 99%

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Intraoperative cardiac arrest management

Ben-Jacob,

Pasch,

Patel

et al. 2023

International Anesthesiology Clinics

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Advanced Cardiac Life Support (ACLS) is an extension of basic life support created to manage patients who experience cardiopulmonary arrest outside the hospital setting. While these guidelines were originally created for community-based emergency services, they were subsequently translated for application in the emergency department and other hospital locations. Given that ACLS has become the mainstay of cardiac arrest management, its algorithms have been adopted for use of patients in the perioperative period. 1 However, cardiac arrest during anesthesia is distinct from that in other settings. Cardiac arrest during anesthesia, although rare, is witnessed and, therefore, may be anticipated. Measures can be taken in advance of circulatory collapse to support a patient's physiology and avoid or delay the need for ACLS. These key differences are associated with better outcomes compared with out-of-hospital or unwitnessed inhospital cardiac arrests. 2,3 This article reviews specific ACLS recommendations and approaches for the management of intraoperative cardiac arrest. Incidence, outcomes, and causes of intraoperative cardiac arrestIntraoperative cardiac arrest (ICA) in the United States is rare, occurring in ~5 to 6 per 10,000 anesthetic cases. [4][5][6] The European Resuscitation Council finds the incidence of perioperative cardiac arrest to range from 4.3 to 34.6 per 10,000 procedures with a 30day mortality of up to 70%. 7,8 Regarding causation, 1 study notes that of 10,000 ICAs, less than one-0.74-was thought to be directly related to anesthesia. 6 Secondary anesthesia-related causes include hypoxia due to failed airway, loss of airway and/or poor ventilation management, hemodynamic instability due to medication administration and side effects, residual neuromuscular blockade, anaphylaxis, iatrogenic injuries from procedures, and complications from regional and neuraxial blocks. Surgical causes such as hemorrhage and trauma must also be considered. 3,7 The etiology of ICA is often readily apparent during a surgical procedure because an arrest is usually witnessed by clinicians familiar with the patient's medical history, and the precipitating cause may be known and rapidly reversible. Thus, initiation of the treatment is usually timely and focused, resulting in better outcomes in terms of survival or residual neurological deficits compared with arrest in other settings. 3,9 Retrospective studies of patients who experienced ICA show one-third surviving hospital discharge, with good neurological outcomes seen in 55% to 66% of the survivors. 7,10

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Section: Cardiac Arrest In the Operating Roommentioning

confidence: 99%

Section: Anaphylaxismentioning

confidence: 99%

Section: Pulmonary Embolismmentioning

confidence: 99%

Section: Pulmonary Embolismmentioning

confidence: 99%

Section: Special Considerations During Intraoperative Arrestmentioning

confidence: 99%

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Intraoperative cardiac arrest management

Ben-Jacob,

Pasch,

Patel

et al. 2023

International Anesthesiology Clinics

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Intraoperacinis Širdies Sustojimas

Grėbliūnas,

Karbonskienė

2023

Health Sciences

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Įvadas. Širdies sustojimas anestezijos ir operacijos metu yra retas įvykis (apie 0,005% visų anestezijų). Šiame straipsnyje apžvelgiami intraoperacinį širdies sustojimą predisponuojantys veiksniai, gydymas ir jo baigtis. Tyrimo tikslas – apžvelgti prieinamą mokslinę literatūrą ir aptarti perioperacinio širdies sustojimo rizikos veiksnius bei priežastis, charakteristikas, gydymą ir jo baigtis. Tyrimo medžiaga ir metodai. Mokslinės literatūros paieška buvo atlikta naudojant PubMed ir Google mokslinčiaus duomenų bazes. Paieškai naudoti raktažodžiai ir jų kombinacijos anglų kalba: intraoperative cardiac arrest, intraoperative resuscitation, resuscitation in operating room (intraoperacinis širdies sustojimas, intraoperacinis gaivinimas, gaivinimas operacinėje). Į literatūros analizę įtraukta 100 publikacijų, iš kurių buvo atrinkti 22 moksliniai straipsniai, atvejų apžvalgos bei tyrimų ataskaitos, kuriose aptariamas gaivinimas bei širdies sustojimas operacinėje. Rezultatai. Didžioji dalis gaivinimų vyksta širdies, krūtinės bei angiochirurgijos operacijų metu. Intraoperacinį širdies sustojimą dažniausiai sukelia chirurginių procedūrų komplikacijos, tokios kaip kraujavimas, hipovolemija, autonominės nervų sistemos stimuliacija. Pagrindiniams paciento rizikos veiksniams priskiriamas širdies nepakankamumas ir plaučių kraujotakos sutrikimai, su širdies sustojimais siejama ir aukšta (IV-V) ASA klasė. Įvykus intraoperaciniam širdies sustojimui, nutraukiami chirurginiai veiksmai, pradedamas kardiopulmoninis gaivinimas pagal ALS algoritmus. Per 90 dienų nuo intraoperacinio širdies sustojimo miršta apie pusė jį patyrusių pacientų.

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Management of Intraoperative Cardiac Arrest

Cited by 2 publications

References 63 publications

Intraoperative cardiac arrest management

Intraoperative cardiac arrest management

Intraoperacinis Širdies Sustojimas

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