POSTOPERATIVE CARDIAC ARREST IN CARDIAC SURGERY PATIENTS

Posted by e-Medical PPT Wednesday, January 8, 2014
Cardiac arrest following major cardiac surgery: 0.7-2.9%
Usually preceded by physiological deterioration,
    although it can occur suddenly in stable patients
Specific causes of cardiac arrest (all potentially reversible):
    tamponade, hypovolemia, myocardial ischaemia, pacing failure,
    or tension pneumothorax

Cardiac arrest after cardiac surgery:

If treated promptly survival rate is relatively high.
Rate of survival to hospital discharge is 54% to 79% in adults and 41% in children.
Key to the successful resuscitation of cardiac arrest in these patients is to perform emergency resternotomy early, especially in the context of tamponade or haemorrhage, where external chest compressions may be ineffective.

Cardiac arrest is defined as the absence of any spontaneous circulation:
    MAP < 30 mmHg
    non-pulsatile waveform

Near cardiac arrest is defined as:
    MAP 30 - 50 mmHg
    pulsatile waveform

Most common causes of cardiac arrest after cardiac surgery:
Ventricular fibrillation
Cardiac tamponade

Initial resuscitation algorithm:

Confirm that hypotension or cardiac arrest is real
Ensure airway / ventilate with manual resuscitator
Avoid prolonged attempts at intubation
Exclude tension pneumothorax
Briefly disconnect pacer to R/O VF
Discontinue hypotensive agents and sedatives
Ensure vasoactive drugs are being delivered
Consider early chest reopening in all patients
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