Pediatric Advanced Life Support for the Anesthesiologist

Pediatric advanced life support guidelines published by the American Heart Association are designed for resuscitation in a broad range of scenarios and environments. The perioperative environment is unlike most others in that the majority of arrests are witnessed, the patients are being monitored at the time of arrest, and the reason for the arrest may be related to the intervention or treatment. In this chapter, the perioperative period is defined as the period during which the patient is cared for by the anesthesia team and focuses on events that occur in the operating room, procedural areas, and diagnostic imaging areas from the time the patient is first seen by the anesthesia team until the patient is transferred to another service or is discharged home or to another facility. Cardiac arrest is defined as a ‘‘no-flow’’ state requiring chest compressions (open or closed chest) or failure to wean from cardiopulmonary bypass. The overall goal of all perioperative resuscitative efforts is to minimize this no-flow period and to maximize the chance for return of spontaneous circulation. Whereas the indications for resuscitation outside of the operating room may be simple (loss of consciousness, loss of pulse, etc.), the indications in the perioperative period may be more complex. They may include inadequate heart rate or blood pressure based on age, inadequate minute ventilation, cyanosis, failure of noninvasive blood pressure monitoring or pulse oximetry, loss of arterial waveform, or a sudden change in the end-tidal carbon dioxide (ETCO2) waveform or value. 1