Life Or Death: Cardiopulmonary Arrest During Surgery Part Two

Life Or Death: Cardiopulmonary Arrest During Surgery Part Two

Life or Death: Cardiopulmonary Arrest During Surgery Part Two

Abstract

This lecture is the second in a two part series and takes an advanced look at cardiopulmonary arrest during surgical procedures and in the immediate post operative period. It continues directly on from Part One of the series with a short refresh on CPR and continues on with a detailed look at advanced life support techniques and postresuscitationcare.

Learning outcomes

  • An understanding of CPR, basic life support and advanced life support
  • Confidence in responding to cardiopulmonary arrest during surgery and in the post operative period.
  • Knowledge in life support and post resuscitation care

Course Notes

Basic Life Support – Ventilation

  • If already intubated under GA, check tube in correct position, and check tube is patent. (obstruction, kinked etc)
  • If intubated, continuous chest compressions with simultaneous ventilation are recommended
  • Ventilate dogs and cats at a rate of 8-10 breaths per minute with a tidal volume of 10ml/kg and an inspiratory time of 1 second.

Advanced Life Support Drug Administration

•Intratracheal drug administration

•Use double the dose and dilute with saline

•Administer via a catheter longer than the ET tube

•Drugs that may be delivered by this route:

–N – Naloxone

–A – Atropine

–V – Vasopressin

–E – Epinephrine

–L – Lidocaine

•Risk depot-effect due to low pulmonary blood flow and uncertain dose-effect relationship

Signs of effective resuscitation

•Return of spontaneous circulation

•Palpable pulses/Doppler etc

•End Tidal CO2 measurement.

•Mucous membrane colour

•Pupilary light response

•Eye position within orbit

•Spontaneous breathing

Post Resuscitation Care

•Main concerns now repeat arrest, and cerebral injury from hypoxia and oedema.

•Ischaemia, then reperfusion, injury, release of chemicals formed during hypoxia- seizures, blindness, sensory deficits, cardiovascular collapse.

•Neuro status-consciousness, movement, PLR, respiration rate and pattern.

•Normal brain function possible if CPCR started within 1-3 minutes. But clinical signs of brain damage may not show until 4-12hrs after resuscitation.

•Mannitol and management of increased ICP as before.

Post Resuscitation Care Aims

  • Maintenance of normal ventilation and oxygenation
  • Maintenance of normal circulating volume, arterial and central venous pressures
  • Minimise arrhythmias – continuous ECG monitoring
  • Correct and maintain acid-base, electrolyte and glucose abnormalities
  • Assess CNS status – level of consciousness
  • Provide adequate sedation and analgesia
  • Optimise blood pressure
  • Optimise oxygenation
  • Optimise ventilation
  • Optimise cardiac output
  • Optimise vital organ perfusion

Typical Crash Plan

  1. Note time
  2. Alert other members of staff
  3. Start compressions approx 100-120 bpm
  4. Secure airway and start ventilation at 8-10 bpm and 100% O2 connect to capnograph if at all possible
  5. Continue for at least 2 mins
  6. Additional personnel secure IV access, apply ECG and other monitoring; one person should write down all interventions
  7. Administer adrenaline and atropine if no ECG applied, asystole or PEA
  8. Assess for return of spontaneous circulation
  9. Assess ECG
  10. Defibrillate if necessary

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