Cardiac surgery resuscitation: time for a new standard?

ardiac arrest in someone who hasundergone heart surgery is quitedifferent than other patient popula-tions. While it seems obvious that apatient who has undergone a sterno-tomy, induced asystole, cardiopulmo-nary bypass, aortic cross-clamping,and hypothermia has uniquely differ-ent reasons for arrest (and methods tocorrect it) than others, little has beenwritten about this important issue. Upto 5000 cardiac surgery patients expe-rience a postoperative arrest situationannually in the United States andstandard resuscitation algorithms, de-signed primarily for those experiencingout-of-hospital events, have proven tobe inadequate and potentially harmful.With a greater appreciation ofimportant distinctions between thesepatients vs others, comes a new way ofthinking about their optimal arrestmanagement that is long overdue.CHEST COMPRESSIONSAdvanced cardiac life support (ACLS)has become a standard of care foremergency response in the acute caresetting. These algorithms advocateexternal cardiac compressions (ECC)as an essential component of initialresuscitation efforts for virtually all ar-rest situations, and healthcare workersare well conditioned to perform ECCupon finding an arrest victim.