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: 3.3). 04/2009; 36(1):3-28. DOI: 10.1016/j.ejcts.2009.01.033
Source: PubMed


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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    • "They reported successful use of this method in another patient who required resuscitation after transcatheter aortic valve implantation. Rottenberg and collaborators [3] suggested that damage to the percutaneous valve could be explained by a study of transoesophageal echocardiography performed during standard CPR in 34 adults showing significant narrowing of the left ventricular outflow tract (LVOT) (59% of patients) or the aortic root including the aortic valve (41% of patients), with the degree of compression at the area of maximal compression ranging from 19% to 83% (mean ± SD = 49 ± 19%). Computed tomography (CT) assessments of adults estimate that when chest compressions are performed over the internipple line (the adult guidelines recommended hand position), the ascending aorta (AA) (18.0%), the root of aorta (48.7%), the left ventricular in-flow tract (LVIT) (20.6%) or LVOT (12.7%) were the structures underlying the "compression point of the sternum" (or area of maximal compression underneath the sternum) [4]. "

    Preview · Article · Jul 2014 · Interactive Cardiovascular and Thoracic Surgery
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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.
    Full-text · Article · May 2014 · Interactive Cardiovascular and Thoracic Surgery
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    • "Cardiac arrest during cardiac surgery is a unique situation. In 2009, the European Society of Cardiothoracic Surgery published a separate guideline that addressed these particular situations, including the timing of emergency resternotomy, the number of attempts at defibrillation before reopening, the administration of epinephrine, and emergency resternotomy sets [1]. However, this guideline did not address the treatment of patients with a mechanical assist device in cardiac arrest situations since their treatment is highly complicated. "
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    ABSTRACT: We present a case in which a patient with a previous sternotomy and left ventricular assist device (LVAD) implantation developed cardiac arrest during resternotomy for LVAD exchange. The surgeon refused chest compressions for fear of potential damage to the inflow cannula directly beneath the sternum. The perioperative team had no alternatives to external cardiac massage other than rapid deployment of extra-corporeal membrane oxygenation for mechanical support, so the anesthesiologist advised the nursing personnel to perform abdominal only cardiopulmonary resuscitation while the surgeon performed a femoral bypass to cannulate the groin for extra-corporeal membrane oxygenation support.
    Full-text · Article · Jul 2011 · Journal of Cardiothoracic Surgery
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