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Intraoperative Cardiac Arrest: Difference between revisions
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'''<u>Incidence of Perioperative Cardiac Arrest (CA):</u>''' | <ref>Fister N, Syed A, Tobias JD. Intraoperative Cardiac Arrest: Immediate Treatment and Diagnostic Evaluation. J Med Cases. 2021 Jan;12(1):18-22. doi: 10.14740/jmc3579. Epub 2020 Nov 18. PMID: 34434422; PMCID: PMC8383635.</ref>'''<u>Incidence of Perioperative Cardiac Arrest (CA):</u>''' | ||
Increase with higher ASA status | Increase with higher ASA status | ||
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Children (<12 year old): 2x more likely to experience CA, infants (<1 year old): 10x, neonates (<1month old): 50x | Children (<12 year old): 2x more likely to experience CA, infants (<1 year old): 10x, neonates (<1month old): 50x | ||
'''<u>Causes for Pediatric Perioperative Arrest:</u>''' | |||
'''<u>Causes for Pediatric Perioperative Arrest:</u>''' | <ref>Shaffner DH, Heitmiller ES, Deshpande JK. Pediatric perioperative life support. Anesth Analg. 2013 Oct;117(4):960-979. doi: 10.1213/ANE.0b013e3182a1f3eb. Epub 2013 Sep 10. PMID: 24023023.</ref>'''<u>Causes for Pediatric Perioperative Arrest:</u>''' | ||
* CIRCULATORY FAILURE: | * CIRCULATORY FAILURE: | ||
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** Overdose - Weight-based dosing of IV anesthetic on induction in a child with hypovolemia or compensated shock may lead to collapse | ** Overdose - Weight-based dosing of IV anesthetic on induction in a child with hypovolemia or compensated shock may lead to collapse | ||
'''<u>Important Resuscitation Steps:</u>''' | |||
<ref>Source: Shaffner DH, Heitmiller ES, Deshpande JK. Pediatric perioperative life support. Anesth Analg. 2013 Oct;117(4):960-979. doi: 10.1213/ANE.0b013e3182a1f3eb. Epub 2013 Sep 10. PMID: 24023023.</ref>'''<u>Important Resuscitation Steps:</u>''' | |||
# Inform team | # Inform team | ||
# Stop surgical stimulation | # Stop surgical stimulation | ||
# Stop anesthetics ( | # Stop anesthetics (volatiles & sedation infusion) and vasodilatory meds | ||
# 100% Oxygen | # 100% Oxygen | ||
# Open fluids and Trendelenburg position | # Open fluids and Trendelenburg position | ||
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[[File:Prone Chest Compression.jpg|thumb|Prone Chest Compression (Shaffner et al. 2013)]] | [[File:Prone Chest Compression.jpg|thumb|Prone Chest Compression (Shaffner et al. 2013)]] | ||
'''<u>Methods of Measuring Effectiveness of CPR</u>''' | |||
'''<u>Methods of Measuring Effectiveness of CPR</u>''' | '''<u>Methods of Measuring Effectiveness of CPR</u>''' | ||
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* MVO2 | * MVO2 | ||
** <30% was associated with no ROSC | ** <30% was associated with no ROSC | ||
'''<u>Post Resuscitation:</u>''' | '''<u>Post Resuscitation:</u>''' | ||
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* Avoid hypoglycemia | * Avoid hypoglycemia | ||
* Avoid hyperventilation (unless herniating) | * Avoid hyperventilation (unless herniating) | ||
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* If the patient has IV or IO access, then a lower dose of succinylcholine should be used to break laryngospasm (0.3–1.0 mg/kg) | * If the patient has IV or IO access, then a lower dose of succinylcholine should be used to break laryngospasm (0.3–1.0 mg/kg) | ||
* Of note, don’t need to aspirate before IM injection | * Of note, don’t need to aspirate before IM injection | ||
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Neurosurgeon should immediately tap the VP shunt to remove cerebrospinal fluid (CSF) and reduce ICP. | Neurosurgeon should immediately tap the VP shunt to remove cerebrospinal fluid (CSF) and reduce ICP. | ||
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CPR and vasopressor administration may be needed | CPR and vasopressor administration may be needed | ||
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Alkalosis Hyperventilation (can see immediate decrease in T waves) | Alkalosis Hyperventilation (can see immediate decrease in T waves) | ||
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Max total dose 10 mL/kg of lipid emulsion over 30 minutes | Max total dose 10 mL/kg of lipid emulsion over 30 minutes | ||
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Serum tryptase level is a useful indicator that mast cell degranulation occurred. The test for serum tryptase is time sensitive and needs to be obtained within 3 hours | Serum tryptase level is a useful indicator that mast cell degranulation occurred. The test for serum tryptase is time sensitive and needs to be obtained within 3 hours | ||