Elsevier

Resuscitation

Volume 40, Issue 2, March 1999, Pages 107-110
Resuscitation

The management of non-traumatic cardiac arrest in the operating room with cardiopulmonary bypass

https://doi.org/10.1016/S0300-9572(99)00009-XGet rights and content

Abstract

We present a case of a 29-year-old woman whom, while undergoing an elective gynecological procedure, acutely arrested. Closed chest cardiopulmonary compressions were not effective. Fortuitously, the cardiac surgical team was in an adjacent operating room, about to start an elective bypass case. After sternotomy, the patient was placed on cardiopulmonary bypass within 20 min of the arrest. The patient achieved return of spontaneous circulation and was ultimately discharged with only mild extremity weakness. The etiology of the arrest was never fully explained. Open chest massage and cardiopulmonary bypass should be considered early in the management of unexpected cardiac arrest, especially in the operating room where surgical expertise should be immediately available. Surgeons and anesthesiologists need to be aware of, and consider, the possibility of employing these techniques.

Introduction

Survival with acceptable neurological function after cardiac arrest requires early restoration of effective cardiac output. This in turn is linked to the development of effective coronary perfusion pressure (CoPP), usually felt to be 15 mmHg [1], [2]. Standard external cardiopulmonary resuscitation (SECPR) often fails to generate sufficient CoPP and end organ perfusion [2], [3]. Both open-chest CPR (OCCPR) and emergent cardiopulmonary bypass (CPB), when applied within 20–30 min of arrest, appear to result in improved outcomes [4], [5], [6]. We present a case of a young woman who suffered an acute cardiac arrest in the OR. Because SECPR was incapable of achieving return of spontaneous circulation (ROSC), she underwent both OCCPR and CPB with a successful outcome. The indications, timing and relative merits of these aggressive interventions are discussed.

Section snippets

Case report

A 29-year-old woman was transferred to the University of Alberta to undergo a hysterectomy for persistent menorrhagia and fibroids. Her history was significant for hypertension (baseline blood pressures 190/110 mmHg), for which she had been treated with beta-blockers with only minimal success. She had been scheduled to undergo the procedure at another institution 2 weeks previously but had developed acute hypotension alternating with marked hypertension just prior to induction. The procedure

Discussion

The management of non-traumatic arrest in the OR should, in theory, be easier than under any other circumstances. Obviously, the majority of patients who do deteriorate have co-existing conditions that complicate their care but this should be some what compensated for by the advantages of prior evaluation, available monitoring to assess the efficacy of resuscitation and evaluate potential etiologies, the fact that the arrest is witnessed and immediate airway control. Perhaps the most

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