Anesthesia advanced circulatory life support

Revista Brasileira de Anestesiologia, 2011

Background and objectives: The new cardiopulmonary resuscitation (CPR) guidelines emphasize the importance of high-quality chest compressions and modify some routines. The objective of this report was to review the main changes in resuscitation practiced by anesthesiologists. Contents: The emphasis on high-quality chest compressions with adequate rate and depth allowing full recoil of the chest and with minimal interruptions is highlighted in this update. One should not take more than ten seconds checking the pulse before starting CPR. The universal relationship of 30:2 is maintained, modifying its order, initiating with chest compressions, followed by airways and breathing (C-A-B instead of A-B-C). The procedure "look, listen, and feel whether the patient is breathing" was removed from the algorithm, and the use of cricoid pressure during ventilations is not recommended any more. The rate of chest compressions was changed for at least one hundred per minute instead of approximately one hundred per minute, and its depth in adults was changed to 5 cm instead of the prior recommendation of 4 to 5 cm. The single shock is maintained, and it should be of 120 to 200 J when it is biphasic; and 360 J when it is monophasic. In advanced cardiac life support, the use of capnography and capnometry to confirm intubation and monitoring the quality of CPR is a formal recommendation. Atropine is no longer recommended for routine use in the treatment of pulseless electrical activity or asystole. Conclusions: Updating the phases of the new CPR guidelines is important, and continuous learning is recommended. This will improve the quality of resuscitation and survival of patients in cardiac arrest.

Wiener klinische Wochenschrift, 2013

Cardiac arrest is classified as an 'in-hospital' if it occurs in a hospitalised patient who had a pulse at the time of admission. A probability of patient's survival until hospital discharge is very low. The reasons for this are old age, multiple comorbidity of patients, late recognition of cardiac arrest, poor knowledge about basic life support algorithm, insufficient equipment, absence of qualified resuscitation teams and poor organization.

Critical Care, 2023

Resuscitation, 2003

The National Registry of Cardiopulmonary Resuscitation (NRCPR) is an American Heart Association (AHA)-sponsored, prospective, multisite, observational study of in-hospital resuscitation. The NRCPR is currently the largest registry of its kind. The purpose of this article is to describe the NRCPR and to provide the first comprehensive, Utstein-based, standardized characterization of in-hospital resuscitation in the United States. All adult ( ]/18 years of age) and pediatric ( B/18 years of age) patients, visitors, employees, and staff within a facility (including ambulatory care areas) who experience a resuscitation event are eligible for inclusion in the NRCPR database. Between January 1, 2000, and June 30, 2002, 14 720 cardiac arrests that met inclusion criteria occurred in adults at the 207 participating hospitals. An organized emergency team is available 24 h a day, 7 days a week in 86% of participating institutions. The three most common reasons for cardiac arrest in adults were (1) cardiac arrhythmia, (2) acute respiratory insufficiency, and (3) hypotension. Overall, 44% of adult in-hospital cardiac arrest victims had a return of spontaneous circulation (ROSC); 17% survived to hospital discharge. Despite the fact that a primary arrhythmia was one of the precipitating events in nearly one half of adult cardiac arrests, ventricular fibrillation (VF) was the initial pulseless rhythm in only 16% of inhospital cardiac arrest victims. ROSC occurred in 58% of VF cases, yielding a survival-to-hospital discharge rate of 34% in this subset of patients. An automated external defibrillator was used to provide initial defibrillation in only 1.4% of patients whose initial cardiac arrest rhythm was VF. Neurological outcome in discharged survivors was generally good. Eighty-six percent of patients with Cerebral Performance Category-1 (CPC-1) at the time of hospital admission had a postarrest CPC-1 at the time of hospital discharge. # Julho de 2002 ocorreram 14720 paragens cardíacas, em adultos, de 207 hospitais participantes que cumpriram critérios de inclusão. Em 86% das instituiçõ es participantes está disponível uma equipe de emergência organizada 24 horas por dia, 7 dias por semana. As 3 razõ es mais frequentes para paragem cardíaca nos adultos foram: (1) arritmia cardíaca, (2), insuficiência respirató ria aguda e (3) hipotensão. Globalmente, 44% dos adultos vítimas de paragem cardíaca intrahospitalar tiveram retorno da circulação espontânea (ROSC); 17% sobreviveram até alta hospitalar. Apesar do facto de uma arritmia primária ser um dos eventos precipitantes em cerca de metade das paragens cardíacas nos adultos, a fibrilhação ventricular (VF) foi o ritmo sem pulso inicial em apenas 16% das vítimas de paragem cardíaca intrahospitalar. Em 58% dos casos de VF ocorreu ROSC, resultando uma taxa de sobrevida até alta hospitalar de 34% neste subgrupo de doentes. Um desfibrilhador automático externo foi usado para administrar a desfibrilhação inicial em apenas 1,4% dos doentes em que o ritmo cardíaco inicial de paragem foi VF. O resultado neuroló gico nos sobreviventes com alta foi na generalidade bom. Oitenta e seis por cento dos doentes com Categoria de Performance Cerebral Á/1 (CPC-1) no momento da admissão hospitalar tiveram CPC-1 pó s-paragem no momento da alta hospitalar. #

Intensive Care Medicine, 2007

2010

Anesthesia & Analgesia, 2018

Funding: This review was developed from previous iterations on behalf of the American Society of Anesthesiologists and the Society of Critical Care Anesthesiologists. Portions of those documents appear verbatim and are used with the permission of the ASA. Conflicts of Interest: See Disclosures at the end of the article. Listen to this Article of the Month podcast and more from OpenAnesthesia.org® by visiting http://journals.lww.com/anesthesia-analgesia/pages/default.aspx. Implication statement: The spectrum of causes of periprocedural cardiac arrest warrants specific adaptations of the advanced circulatory life support algorithms. A number of rare, life-threatening etiologies of profound hemodynamic and respiratory disturbance leading to cardiac arrest are reviewed. Good patient outcomes in these special situations can be achieved by vigilance, timely formulation of a differential diagnosis for the crisis, and adherence to best practices.

1993

para conocer datos sobre la realidad del paro cardiorrespiratorio durante el periodo comprendido entre los meses de julio y octubre de 2010. Metodología. Se trata de un estudio prospectivo, observacional; se diseñó un registro de paro cardiorrespiratorio, se difundió y se pidió que lo llenaran los médicos del hospital que participaron en maniobras de reanimación cardiopulmonar en el período descrito. Resultados. Se presentaron 22 casos de paro cardiorrespiratorio; el 80 % ocurrieron en el servicio de urgencias, y el 95 % fueron atendidos por SummARy Background. There are no publications in Colombia regarding the implementation of a hospital cardiopulmonary arrest registry despite the fact that the International Liaison Committee on Resuscitation (ILCOR) already in 1991 developed, in a meeting at Utsein Abbey in Norway, a form designed to compare and improve cardiopulmonary resuscitation maneuvers. The purpose of this work was to apply a cardiopulmonary arrest registry in the Utstein style at San Juan de Dios Hospital in Cali, in order to gather data concerning the reality of cardiopulmonary arrest, during the period between July and October, 2010. Methodology. Prospective observational study. A cardiopulmonary arrest form was developed and communicated, and all physicians who had participated in cardiopulmonary resuscitation maneuvers during the study period were asked to complete the form.

Drug, Healthcare and Patient Safety

Purpose: Perioperative cardiac arrests (CAs) are a rare but catastrophic perioperative complication. Much about incidence, risk factors, and outcomes of such events are still unknown. This study investigated anesthesia-related CAs at a tertiary teaching hospital. Methods: CA incidence within 24 hours of anesthesia administration was prospectively identified from May 1, 2016 to April 31, 2019. Each CA was matched by four other cases without CA receiving anesthesia on the same date and under similar operating conditions. The CA cases were reviewed and assigned to one of three groups: anesthesia-related, anesthesia-contributing, and anesthesia not related. Results: A total of 58,303 patients underwent 73,557 procedures under anesthesia during the study period. In sum, 27 CAs were reported for incidence of 3.7 per 10,000 anesthesia administrations (95% CI 2.3-5.1). Eleven CA were anesthesia-related for incidence of 1.5 per 10,000 anesthesia administrations. Four CA cases were anesthesia-contributing for incidence of 0.5 per 10,000 anesthesia administrations, while 53% of the anesthesia-related and-contributing CAs were due to respiratory problems. American Society of Anesthesiologists (ASA) physical status score, cardiovascular surgery, emergency surgery, and increased duration of surgery were significantly correlated with CA incidents when compared to the control group. ASA physical status score is an independent risk factor of the occurrence of perioperative CA (OR 7.6, 95% CI 2.6-22.4; P<0.001). Conclusion: Identifying factors associated with increased risk for anesthesia-related CA is of great importance in risk stratification for surgical patients. ASA physical status score was found to be a major factor in predicting perioperative CA, since patients with higher ASA scores had a statistically significant increased risk of CA. Therefore, extra precautions must be taken when dealing with unprepared patients who have uncontrolled medical illnesses, especially those who will be undergoing emergency surgery.

Risk Management and Healthcare Policy, 2014

To determine the initial success rate and its associated factors on cardiopulmonary resuscitation (CPR) in patients with cardiac arrest within 24 hours after receiving anesthesia for an emergency surgery. Patients and methods: After the hospital ethical committee gave approval for this study, the anesthesia providers recorded all relevant data regarding CPR in patients with cardiac arrest within 24 hours after anesthesia for emergency surgery at Maharaj Nakorn Chiang Mai Hospital, a university hospital in Northern Thailand. Only data from the cardiac arrest patients who received the first CPR attempt were included in the analysis. The end point of the initial success of CPR was return of spontaneous circulation (ROSC). Factors related to ROSC were determined by univariate analyses and multiple logistic regression analysis. The odds ratios (OR) and 95% confidence intervals (CI) were used to calculate the strength of the factors associated with the ROSC. Results: Of the 96 cardiac arrest patients, 44 patients (45.8%) achieved ROSC. Factors associated with ROSC were electrocardiogram monitoring for detected cardiac arrest (OR =4.03; 95% CI =1.16-14.01; P=0.029), non-shock patients before arrest (OR =8.54; 95% CI =2.13-34.32; P=0.003), timing to response of activated CPR team within 1 minute (OR =9.37; 95% CI =2.55-34.39; P,0.001), having trained CPR teams (OR =8.76; 95% CI =2.50-30.72; P,0.001), and administration of more than one dose of epinephrine (OR =5.62; 95% CI =1.32-23.88; P,0.019). Conclusion: Patients undergoing anesthesia for an emergency surgery are at risk for perioperative cardiac arrest with high mortality which requires immediate CPR. Our results have confirmed that early detection of cardiac arrest by vigilant electrocardiogram monitoring and prompt management with a qualified team are important factors in improving the success of CPR. Emergency surgical patients at risk for cardiac arrest should be promptly managed, with facilities available not only during the operation but also during the pre-to postoperative period.