Resuscitation practices in cardiac surgery

Abstract

During the past decade, there has been an increasing recognition that cardiac surgery patients have different resuscitative needs than other medical and surgical patients who experience in-hospital cardiac arrest. The special resuscitative needs of cardiac surgery patients were addressed in the 2010 European Resuscitation Council Guidelines for Resuscitation in the section reviewing cardiac arrest in special circumstances and the 2010 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care in Special Situations. To date, the most comprehensive and current analysis of survival to hospital discharge after an inhospital cardiac arrest included 84,625 patients at 374 hospitals, 79.3% of whom had asystole or pulseless electrical activity and 20.7% of whom had pulseless ventricular tachycardia as their initial rhythm. Although that study excluded patients in operating rooms, procedural suites, and emergency departments because of their distinct clinical circumstances, the risk-adjusted rate of survival to hospital discharge was 22.3% in 2009, markedly improved compared with 13.7% in 2000. Given the continuous monitoring of patients in the intensive care units (ICUs), which decreases the risk of an unwitnessed cardiac arrest and the delay to initiation of cardiopulmonary resuscitation (CPR), cardiac arrests in ICUs represent a subgroup within the in-hospital cardiac arrest group. Although the postcardiac arrest survival rates among the patients in ICUs have varied widely (0%79%), cardiac surgery patients seem to fare better. From 2 separate studies, the survival to discharge among cardiac surgery patients who experienced an in-hospital cardiac arrest was 60% to 79%, with 45% to 69% survival at 1 year follow-up. The differences in survival after a cardiac arrest in the cardiac surgery ICUs compared with other in-hospital cardiac arrests are likely related to the high incidence of cardiac arrests resulting from reversible causes, underscoring the need for, and importance of, a protocolbased, standardized approach to CPR in the cardiac surgery ICU.