Guideline for resuscitation in cardiac arrest after cardiac surgery

Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK.
European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery (Impact Factor: 2.81). 04/2009; 36(1):3-28. DOI: 10.1016/j.ejcts.2009.01.033
Source: PubMed

ABSTRACT The Clinical Guidelines Committee of the European Association for Cardio-Thoracic Surgery provides this professional view on resuscitation in cardiac arrest after cardiac surgery. This document was created using a multimodal methodology for evidence generation including the extrapolation of existing guidelines from the International Liaison Committee on Resuscitation where possible, our own structured literature reviews on issues particular to cardiac surgery, an international survey on resuscitation hosted by CTSNet and manikin simulations of potential protocols. This protocol differs from existing generic guidelines in a number of areas, the most import of which are the following: successful treatment of cardiac arrest after cardiac surgery is a multi-practitioner activity with six key roles that should be allocated and rehearsed on a regular basis; in ventricular fibrillation, three sequential attempts at defibrillation (where immediately available) should precede external cardiac massage; in asystole or extreme bradycardia, pacing (where immediately available) should precede external cardiac massage; where the above measures fail, and in pulseless electrical activity, early resternotomy is advocated; adrenaline should not be routinely given; protocols for excluding reversible airway and breathing complications and for safe emergency resternotomy are given. This guideline is subject to continuous informal review, and when new evidence becomes available.

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    • "This theoretical risk is thought to be greater with larger preperitoneal devices, such as HeartMate II [2]. The 2009 European Association for Cardio-Thoracic Surgery guidelines on resuscitation following cardiac surgery [3] do not address this particular scenario, possibly because of a paucity of evidence at the time of guideline generation. Controversy remains regarding the risk of ECC in patients with LVADs. "
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    ABSTRACT: A best evidence topic was written according to a structured protocol to determine whether there is evidence that cardiopulmonary resuscitation (CPR) by compressing the chest is safe and effective in patients with left ventricular assist devices (LVADs). Manufacturers warn of a possible risk of device dislodgement if the chest is compressed. AMED, EMBASE, MEDLINE, BNI and CINAHL were searched from inception to March 2014. Animal studies, case reports, case series, case-control studies, randomized controlled studies and systematic reviews were eligible for inclusion. Opinion articles with no reference to data were excluded. Of 45 unique results, 3 articles merited inclusion. A total of 10 patients with LVADs received chest compression during resuscitation. There was no report of device dislodgement as judged by postarrest flow rate, autopsy and resumption of effective circulation and/or neurological function. The longest duration of chest compression was 150 min. However, there are no comparisons of the efficacy of chest compressions relative to alternative means of external CPR, such as abdominal-only compressions. The absence of high-quality data precludes definitive recommendation of any particular form of CPR, in patients with LVADs. However, data identified suggest that chest compression is not as unsafe as previously thought. The efficacy of chest compressions in this patient population has not yet been investigated. Further research is required to address both the safety and efficacy of chest compressions in this population. Urgent presentation and publication of further evidence will inform future guidance.
    Interactive Cardiovascular and Thoracic Surgery 05/2014; 19(2). DOI:10.1093/icvts/ivu117 · 1.11 Impact Factor
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    • "The incidence of perioperative cardiac arrest after open heart surgery ranges from 0.7% to 2.9% [1] [2] [3] and has decreased in recent years. Survival to hospital discharge of these patients, while higher if compared to other hospital settings, is variable, ranging from 17% to 79% [4]. Extracorporeal perfusion support (ECPS), aimed at improving survival during cardiopulmonary resuscitation (CPR), was introduced by Mattox and Beall over three decades ago [5]. "
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    ABSTRACT: Early institution of extracorporeal perfusion support (ECPS) may improve survival after cardiac arrest. Two patients sustained unexpected cardiac arrest in the Intensive Care Unit (ICU) following cardiac interventions. ECPS was initiated due to failure to restore hemodynamics after prolonged (over 60 minutes) advanced cardiac life support (ACLS) protocol-guided cardiopulmonary resuscitation. Despite relatively late institution of ECPS, both patients survived with preserved neurological function. This communication focuses on the utility of ECPS in the ICU as a part of resuscitative efforts.
    Anesthesiology Research and Practice 06/2010; 2010(1687-6962). DOI:10.1155/2010/937215
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    ABSTRACT: A survey was conducted on CTSNet, the cardiothoracic network website in order to ascertain an international viewpoint on a range of issues in resuscitation after cardiac surgery. From 40 questions, 19 were selected by the EACTS clinical guidelines committee. Respondents were anonymous but their location was determined by their Internet protocol (IP) address. The responses were checked for duplication and completion errors and then the results were presented either as percentages or median and range. From 387 responses, 349 were suitable for inclusion from 53 countries. The median size of unit of respondents performed 560 cases per year. The incidence of cardiac arrest reported was 1.8%, emergency resternotomy after arrest 0.5% and emergency reinstitution of bypass 0.2%. Only 32% of respondents follow current guidelines on resuscitation in their unit and an additional 25% of respondents have never read these guidelines. Respondents indicated that they would perform three attempts at defibrillation for ventricular fibrillation without intervening external cardiac massage and for all arrests perform emergency resternotomy within 5 min if within 24h of the operation. Fifty percent of respondents would give adrenaline immediately, 58% of respondents would be happy for a non-surgeon to perform an emergency resternotomy and 76% would allow a surgeon's assistant and 30% an anaesthesiologist to do this. Only 7% regularly practise for arrests, but 80% thought that specific training in this is important. This survey supports the EACTS guideline for resuscitation in cardiac arrest after cardiac surgery published in this issue of the journal.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 05/2009; 36(1):29-34. DOI:10.1016/j.ejcts.2009.02.050 · 2.81 Impact Factor
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