Learning objectives

• Recognize anesthetic complications associated with cardiac arrest
• Recognize cardiac arrest
• Treat cardiac arrest associated with anesthesia

Definition

• Advanced life support is a set of life-saving protocols and skills that extend basic life support to further support the circulation and provide an open airway and adequate ventilation (breathing)
• Is used to provide urgent treatment for cardiac emergencies such as cardiac arrest, stroke, myocardial infarction, and other conditions
• Should only be performed by paramedics and healthcare providers who have undergone more extensive training

Signs of cardiac arrest

• ECG with pulseless rhythm
  • Ventricular tachycardia
  • Ventricular fibrillation
  • Severe bradycardia
  • Asystole
• Loss of:
  • Carotid pulse > 10 seconds
  • End-tidal CO2 on capnograph
  • Arterial line tracing
  • Pulse oximeter signal

Anesthetic complications associated with perioperative cardiac arrest

• Intravenous anesthetic overdose
• Inhalation anesthetic overdose
• Neuraxial block with high-level sympathectomy
• Local anesthetic systemic toxicity
• Malignant hyperthermia
• Drug administration errors

Management of cardiac arrest associated with anesthesia

Post resuscitation care

• Apply invasive monitoring
• Finalize surgical plan and transport patient to ICU
• Perform a full history and examination
• Consider therapeutic hypothermia

Keep in mind

• Defibrillation is only possible if shockable rhythm (VFIB, VTACH) occurs
• Bradycardia and hypotension under general anesthesia are relatively common
• Cardiac arrest in the peri-operative setting is relatively rare and knowing when to initiate CPR can be difficult
• CPR should be established immediately and treatment will depend on the rhythm seen by EKG monitoring

Suggested reading

• Soar J, Böttiger BW, Carli P, et al. European Resuscitation Council Guidelines 2021: Adult advanced life support [published correction appears in Resuscitation. 2021 Oct;167:105-106]. Resuscitation. 2021;161:115-151.
• Moitra VK, Einav S, Thies KC, et al. Cardiac Arrest in the Operating Room: Resuscitation and Management for the Anesthesiologist: Part 1. Anesth Analg. 2018;126(3):876-888.
• Pollard BJ, Kitchen, G. Handbook of Clinical Anaesthesia. Fourth Edition. CRC Press. 2018. 978-1-4987-6289-2.
• McEvoy MD, Thies KC, Einav S, et al. Cardiac Arrest in the Operating Room: Part 2-Special Situations in the Perioperative Period [published correction appears in Anesth Analg. 2018 May;126(5):1797]. Anesth Analg. 2018;126(3):889-903.
• Moitra VK, Gabrielli A, Maccioli GA, O’Connor MF. Anesthesia advanced circulatory life support. Can J Anaesth. 2012 Jun;59(6):586-603. doi: 10.1007/s12630-012-9699-3.

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