Intraoperative Cardiac Arrest: Difference between revisions

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'''<u>Incidence of Perioperative Cardiac Arrest (CA):</u>'''
 
Increase with increased ASA status
 
Wake Up Safe Registry: 3.3 per 10,000 of arrest were anesthesia related. Aesthesia-related death was 0.36 per 10,000 anesthetics.
 
Pediatric Perioperative Cardiac Arrest (POCA) Registry: 1.4 +/- 0.45 per 10,000 were anesthesia related. Mortality rate: 26%
 
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>'''
 
* CIRCULATORY FAILURE:
** Hypovolemia: Hemorrhage, inadequate/inappropriate volume resuscitation/transfusion (patients < 24 months may not respond to hypotension with increase HR)
** Hyperkalemia: Succinylcholine, TRANSFUSION (pRBC >2 weeks, speed of transfusion), reperfusion, myopathy, or renal insufficiency
** Dysrhythmia: LA toxicity, line placement (safer to use Ultrasound guided vs. landmark technique)
** Anaphylaxis
** Venous Air Embolism
** Malignant Hyperthermia: very rare
* RESPIRATORY FAILURE:
** Airway Obstruction:  - Laryngospasm: Upper respiratory infection increases risk  - Bronchospasm
** Inadequate ventilation and oxygenation: difficult airway, mucus plug, kinked ETT, inadvertent extubation
** Disordered control of breathing: drug overdose, neuromuscular diseases, apnea
** Aspiration
* SUDDEN CARDIAC COLLAPSE
** Bradycardia or cardiovascular collapse:  - Traction, pressure, or insufflation involving the abdomen, eye, neck, or heart  - Undiagnosed cardiomyopathy
** 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>'''
 
# Inform team
# Stop surgical stimulation
# Stop anesthetics (gas & sedation gtt)  and vasodilatory meds
# 100% Oxygen
# Open fluids and Trendelenburg position
# Chest-compression
# Call for help
# Consider stopping potassium containing solutions (blood or hyperalimentation)
# Ask for ice to head
# Assign roles
 
'''<u>Resuscitation Algorithm:</u>'''
 
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.
 
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Revision as of 15:45, 18 November 2023

Incidence of Perioperative Cardiac Arrest (CA):

Increase with increased ASA status

Wake Up Safe Registry: 3.3 per 10,000 of arrest were anesthesia related. Aesthesia-related death was 0.36 per 10,000 anesthetics.

Pediatric Perioperative Cardiac Arrest (POCA) Registry: 1.4 +/- 0.45 per 10,000 were anesthesia related. Mortality rate: 26%

Children (<12 year old): 2x more likely to experience CA, infants (<1 year old): 10x, neonates (<1month old): 50x

Causes for Pediatric Perioperative Arrest:

  • CIRCULATORY FAILURE:
    • Hypovolemia: Hemorrhage, inadequate/inappropriate volume resuscitation/transfusion (patients < 24 months may not respond to hypotension with increase HR)
    • Hyperkalemia: Succinylcholine, TRANSFUSION (pRBC >2 weeks, speed of transfusion), reperfusion, myopathy, or renal insufficiency
    • Dysrhythmia: LA toxicity, line placement (safer to use Ultrasound guided vs. landmark technique)
    • Anaphylaxis
    • Venous Air Embolism
    • Malignant Hyperthermia: very rare
  • RESPIRATORY FAILURE:
    • Airway Obstruction: - Laryngospasm: Upper respiratory infection increases risk - Bronchospasm
    • Inadequate ventilation and oxygenation: difficult airway, mucus plug, kinked ETT, inadvertent extubation
    • Disordered control of breathing: drug overdose, neuromuscular diseases, apnea
    • Aspiration
  • SUDDEN CARDIAC COLLAPSE
    • Bradycardia or cardiovascular collapse: - Traction, pressure, or insufflation involving the abdomen, eye, neck, or heart - Undiagnosed cardiomyopathy
    • Overdose - Weight-based dosing of IV anesthetic on induction in a child with hypovolemia or compensated shock may lead to collapse

Important Resuscitation Steps:

  1. Inform team
  2. Stop surgical stimulation
  3. Stop anesthetics (gas & sedation gtt)  and vasodilatory meds
  4. 100% Oxygen
  5. Open fluids and Trendelenburg position
  6. Chest-compression
  7. Call for help
  8. Consider stopping potassium containing solutions (blood or hyperalimentation)
  9. Ask for ice to head
  10. Assign roles

Resuscitation Algorithm:

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.


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Go to the Generalized Suggested Outline for information on case-specific details for each page.

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