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Intraoperative Cardiac Arrest: Difference between revisions
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# Assign roles | # Assign roles | ||
'''<u>Resuscitation Algorithm:</u>''' | '''<u>Resuscitation Algorithm for Intraoperative Pulseless Arrest:</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. | 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. | ||
[[File:PALS Shaffner.jpg|thumb|Intraoperative Pulseless Arrest Resuscitation]] | [[File:PALS Shaffner.jpg|thumb|Intraoperative Pulseless Arrest Resuscitation]]Important Notes: | ||
* Medication have not been shown to change outcome, more emphasis on effective compression. | * Medication have not been shown to change outcome, more emphasis on effective compression. | ||
* Compression depth: | * Compression depth: | ||
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* 100 compressions : 8-10 ventilations per min | * 100 compressions : 8-10 ventilations per min | ||
* Avoid overinflation | * Avoid overinflation | ||
* Biphasic shock | * Biphasic shock - First dose: 2-4J/kg - Second dose: 4J/kg - Third dose: 4-10J/kg | ||
* Epi dose: | * Epi dose: - 10 MICROg/kg IV/IO - 100 MICROg/kg ETT | ||
* PEA vs. VFib: PEA appears organized and pulseless | * PEA vs. VFib rhythm: PEA appears organized and pulseless | ||
* Call for ECMO if no ROSC after 6 mins | * Call for ECMO if no ROSC after 6 mins | ||
* Ice to head | * Ice to head | ||
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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>''' | |||
* ETCO2 levels >10 mm Hg are associated with higher likelihood of ROSC | |||
** >30mmHg: good | |||
** <10 mmHg: bad | |||
* Diastolic pressure on a-line (relaxation right atrial pressure): | |||
** >20 mmHg infants | |||
** >30 mmHg children | |||
** <15 mmHg - bad (in adults associated with no ROSC during CPR) | |||
* MVO2 | |||
** <30% was associated with no ROSC | |||
'''<u>Post Resuscitation:</u>''' | |||
* Avoid hypotension | |||
* Allow to be cool (avoid hyperthermia) | |||
* Avoid hypoglycemia | |||
* Avoid hyperventilation (unless herniating) | |||
'''<u>Critical Event Resources:</u>''' | '''<u>Critical Event Resources:</u>''' | ||
PEDI CRISIS APP | |||
Available on Apple Store and Google Play | Available on Apple Store and Google Play | ||
https://pedsanesthesia.org/pedi-crisis-app/ | |||
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