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Guideline

Guideline for resuscitation in cardiac arrest after cardiac surgery

^a Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
^b Department of Cardiac Surgery, Vicenza Hospital, Italy
^c Department of Cardiothoracic Surgery, University Hospital of Liège, Belgium
^d Department of Cardiothoracic Surgery, North Staffordshire Hospital, Stoke-on-trent, UK
^e Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
^f Department of Cardiothoracic Anaesthesia, Papworth Hospital, Cambridge, UK
^g Institut de Cardiologie, La Pitié Hospital, France
^h Department of Cardiothoracic Anaesthesia, Wythenshawe Hospital, UK
ⁱ Department of Cardiothoracic Surgery, Leiden University Medical Center, Netherlands
^j Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, CB3 8RE, UK

Received 10 November 2008; received in revised form 21 January 2009; accepted 22 January 2009.

^_* Corresponding author. Tel.: +44 1480 364299; fax: +44 1480 364744. (Email: sam.nashef{at}papworth.nhs.uk).

Abstract

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.

Key Words: Cardiac surgery • Resuscitation • Guideline • Thoracic surgery • Cardiac arrest • Cardiac massage

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