Aug 12, 2018
The arrested heart surgery patient is a unique beast in surgery and critical care. Dr Nikki Stamp gives a whirlwind tour of post cardiac surgery resuscitation. She will discuss how to spot the potential arrest, how to manage it and some special situations to be aware of in this special group of patients Post cardiac surgery resuscitation is complex. Nikki describes them as “brown trouser moments”. She highlights this with three cases. A15-year-old girl who exsanguinated on Day 12 after dissection repair in the community. A 40-year-old female arrested within an hour of a re-do aortic root procedure. A 72-year-old lady who arrested after a bradycardic arrest following an aortic valve replacement. Only one survived – this is serious business. Cardiac arrest post cardiac surgery is relatively uncommon. The survival rate is also quite high. This is due to it being recognised and treated early with a high proportion of reversible causes. The key is to think of these causes and treat them as a team. Nikki breaks the causes into four groups. Ischemia, mechanical, arrhythmia and unknown. It is important to recognise that cardiac arrest in this population is differs to a typical scenario of cardiac arrest. As such, there is a different algorithm. This hinges on assessing the rhythm in the first instance and consider defibrillation fist if appropriate. One should also consider the use of pacing wires if they are still in post-operatively. Nikki provides a great number of clinical pearls, discussing care of the right heart, use of chest compressions and cardiac massage, use of ECMO and considerations if a left ventricular assistance device is in place. Her take home points include being alert to these situations but not alarmed! Practice these resuscitations as a team. Shock early and pace early and remember most people should not die with a closed chest!
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