Cardiopulmonary resuscitation (CPR) is a lifesaving emergency procedure utilized in the setting of cardiac arrest. Early recognition and intervention with CPR significantly improves patient survival, both in the community and in the perioperative setting. It is therefore essential for the anesthesiologist to be knowledgeable of standardized CPR components such as emergency medications, defibrillators, and basic life support (BLS) and advanced cardiac life support (ACLS) algorithms.
Basic life support (BLS) is an originally described form of CPR and is often practiced in an out-of-hospital setting or in the hospital before an advanced life support provider arrives. The steps of BLS include recognition of an unresponsive victim, activation of an emergency response system, and initiation of CPR. Providers of BLS may be lay people or health-care providers.
On recognition of a victim, the BLS provider may assess responsiveness by shouting or shaking the victim, while also communicating to activate an emergency response team. Identification of the victim’s pulse is an important next step; if the victim has a pulse, monitoring the situation until emergency professionals arrive is the appropriate response. If the victim is found pulseless, the provider is to initiate CPR with cycles of 30 chest compressions and 2 rescue breaths. Providers check for pulse every 2 minutes during BLS. When emergency equipment arrives, the AED is applied and the provider follows the prompts on the device to analyze the victim’s heart for shockable rhythms. BLS providers then proceed with cycles of CPR, with a pause every 2 minutes for analysis of shockable rhythms by the AED, until there is either a return of spontaneous circulation in the victim or until advanced life support providers arrive at the scene.
Advanced Cardiac Life Support
It is essential for the anesthesiologists to be an expert in ACLS, as he or she is often the identifying emergency provider in the perioperative setting. Advanced life support is a continuation of BLS and is differentiated by several key interventions which include arrhythmia treatment, airway management, medication administration, and transition to post-resuscitation care.
The American Heart Association’s adult cardiac arrest algorithm provides a framework for advanced life support providers to deliver emergency treatment. Pulseless arrest patients have one of the following arrhythmias: ventricular fibrillation, ventricular tachycardia, pulseless electrical activity, or asystole. In each of these scenarios, after chest compressions and defibrillation is utilized, vasopressors may be administered following every 3–5 minutes until CPR has ceased. Identifying and treating reversible causes of cardiac arrest during CPR are helpful in guiding further medical treatment and there are several special considerations for anesthesiologists in the perioperative setting. In an emergency setting, the mnemonic “8 H’s and 8 T’s” can aid in recalling potential causes of arrest: hypovolemia, hypoxia, hydrogen ion acidosis, hyperkalemia and hypokalemia, hypoglycemia, hypothermia, malignant hyperthermia, hypervagal response, toxins, tamponade, tension pneumothorax, thrombosis in ...