- The standard reversible causes of cardiac arrest (4Hs and 4Ts) are still applicable, though the Resus Council say there should be a focus on identifying and correcting:
- Hypovolaemia e.g. from anaphylaxis or bleeding
- Hypoxia e.g. from airway issues
- Tension pneumothorax
- Thrombosis i.e. pulmonary embolism
- The AAGBI are slightly more vague, though no less correct, when they say the cause of arrest is likely to be 'something related to surgery or anaesthesia; the patient’s underlying medical condition; the reason for surgery or equipment failure'
Intra-Operative Cardiac Arrest
Intra-Operative Cardiac Arrest
This page is dedicated to intra-operative cardiac arrest, rather than cardiac arrest occurring outside the theatre environment.
'Generic' cardiac arrest is covered in the ICM section, while there are other pages for maternal cardiac arrest, cardiac arrest while pinned for neurosurgery, arrest following cardiac surgery or for paediatric patients.
There's not yet been an SAQ/CRQ on intra-operative arrest, but SBA/MTF questions on the topic are fairly common.
Resources
- The management of intra-operative cardiac arrest mostly follows a standard ALS algorithm
- Differences in considerations and management are described below
Initial management
- The opening gambit should be familiar:
- Declare cardiac arrest and (delegate someone to) start chest compressions
- Turn off any maintenance anaesthetic
- Call for help and the cardiac arrest trolley
- Check the position of the airway and ensure its patency; NB if EtCO2 is absent then presume oesophageal intubation until absolutely excluded
- Increase the FiO2 to 1.0
- Ensure the breathing system is working adequately
- Can manually ventilate the patient or use the ventilator; if using the ventilator use a volume control mode
- Ensure adequate chest compressions
- Ensure adequate access (IV or IO)
- Drugs are the same, although can give adrenaline incrementally rather than as a 1mg bolus
- Management otherwise follows the standard ALS algorithm
Differences in management
- The Resus Council say we should 'use ultrasound to guide resuscitation' but offer no further information on what that means
- With reference to the relevant reversible courses of cardiac arrest, it is presumably intended to be useful in:
- Checking for oesophageal intubation causing hypoxia, as per the AAGBI guidelines (2022)
- Looking for evidence of pneumothorax
- Point of care echocardiography, looking at the right heart to support a suspected diagnosis of PE (as well as general assessment of cardiac function)
- Aiding assessment of volume status
- The other tidbits from the Resus Council relate to alternative methods of CPR, namely:
- Consider open cardiac compression in place of standard close cardiac compression
- Consider extra-corporeal CPR if conventional CPR is failing e.g. ECMO, CPB