Perioperative cardiac arrest
Although the safety of performed surgeries has significantly increased in recent years, the number of perioperative cardiac arrests remains stable. This may be due to the increasing number of procedures and the higher age of patients. In the following algorithm, you as an anesthesiologist are being called to such a surgery. Are you able to resolve the situation correctly?
Review
The scenario of the algorithm deals with a very dramatic, but not so rare, situation in the operating room. I dare to say that most anaesthesiologists will encounter the problem of circulatory arrest due to hypovolaemia from catastrophic haemorrhage at least once in their practice. This should be a sufficient reason for completing this algorithm.
The algorithm deliberately does not address the complex therapy and management of shock and focuses only on the actions associated with cardiopulmonary resuscitation itself. The authors cannot be faulted here. The procedure is fully in line with current resuscitation recommendations.
I would like to highlight and commend the authors for emphasising 'taking the lead' and 'hands off'. However obvious this may seem, in a real situation the anesthesiologist suddenly finds himself under considerable pressure. And it is the anesthesiologist who makes the decisions and gives instructions to the other staff in the operating theatre, including the surgeons, at any given moment. At the same time, he or she must keep a "free hand" and keep an overview of the situation. In particular, less experienced younger colleagues should practice similar situations so that when the moment comes, they are ready to handle their role lege artis and with clarity! This brings us back to the unquestionable importance of simulations in medicine. But that is another topic.
Sources
LOTT, Carsten, Anatolij TRUHLÁŘ, Annette ALFONZO, et al. European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances. Resuscitation [online]. 2021, 2021(161), 152-219 [cit. 2024-03-05]. doi: https://cprguidelines.eu/assets/guidelines/European-Resuscitation-Council-Guidelines-2021-Ca.pdf
Learning targets
2. The student knows the procedure for managing shockable and non-shockable cardiac rhythms.
3. The student understands the specifics of resuscitation in the operating theatre setting.
Key points
2. Division of roles in the team, good organisation and cooperation - key aspects of successful patient rescue.
3. Specifics of resuscitation in the operating theatre environment.
