2023 Volume 52 Issue 4 Pages 239-243
Cardiac Surgery Advanced Life Support (CALS) has been introduced as a cardiopulmonary resuscitation (CPR) after cardiac surgery since 2006, and has been recommended by Society of Thoracic Surgeons (STS) since 2017 and by the AHA (American Heart Association) guideline since 2020. The modified CALS protocol, which was partially revised to fit Japanese medical situations, was introduced to our hospital in 2019. Of 550 patients who underwent cardiac surgeries from April 2019 through May 2021, 6 patients (1.1%) (mean age: 51.8±27.2 years.) were resuscitated by the CALS protocol. We describe a case of repeated ventricular fibrillation (VF) due to R on T caused by ischemia-reperfusion injury. A 67-year-old man underwent aortic root replacement, total aortic arch repair, and coronary artery bypass surgery for a Stanford A type acute aortic dissection with right coronary artery malperfusion and cardiac tamponade. On the day of surgery, the patient was in VF and returned to sinus rhythm by prompt defibrillation by the ICU staff, but VF repeated every few minutes. Repeated VF was resolved by timely resternotomy, cardiac massage, and percutaneous extracorporeal circulatory support. Chest compression was avoided and the patient was discharged without neurological complications. The CALS protocol has enabled us to perform rapid CPR and resternotomy for cardiac arrest after cardiac surgery.
