Management of cardiac arrest after cardiac surgery

Abstract

Cardiac arrest occurs in <5% of patients who undergo cardiac surgery. The mechanisms underlying cardiac arrest include fatal arrhythmias, hemorrhagic shock, cardiac tamponade, and bradycardia. Postoperative cardiac arrest often occurs in the intensive care unit; however, as a medical professional is the bystander at the time of the event, the resuscitation rate is high in this clinical setting. Immediate chest compression is not recommended in patients who develop cardiac arrest after cardiac surgery, in contrast to the practice in standard cardiopulmonary resuscitation, considering the risk of injury to the sutured graft and aortic or cardiac rupture when chest compression is performed too soon after the procedure. Guidelines recommend resuscitation interventions that avoid chest compression for 1 min. Concurrent with that response, preparation for resternotomy is important. Chest compressions aimed at achieving a systolic blood pressure of 60 mm Hg should be initiated if the heartbeat is not restored after a 1-min response. In the first minute after cardiac arrest, three consecutive shocks for shockable rhythms (ventricular fibrillation) should be administered. Shock may be ineffective in cases of severe bradycardia and asystole, and pacing is preferable using the pacing lead inserted intraoperatively; if the 1-min intervention is unsuccessful, open chest cardiac massage with re-sternotomy should be initiated within 5 min. Immediate resternotomy is not recommended after the 10th postoperative day. Simulation training is useful for an appropriate response to cardiac arrest after cardiac surgery.