One discussion this week included intraoperative cardiac arrest.

Reference: Moitra VK, et al. Cardiac arrest in the operating room: resuscitation and management for the anesthesiologist: part 1. Anesthesia & Analgesia. 2018 Mar;126(3):876-888. doi: 10.1213/ANE.0000000000002596.

Summary: Cardiac arrest in the operating room and procedural areas has a different spectrum of causes (ie, hypovolemia, gas embolism, and hyperkalemia), and rapid and appropriate evaluation and management of these causes require modification of traditional cardiac arrest algorithms. There is a small but growing body of literature describing the incidence, causes, treatments, and outcomes of circulatory crisis and perioperative cardiac arrest. These events are almost always witnessed, frequently known, and involve rescuer providers with knowledge of the patient and their procedure.

Cardiac arrest in the periprocedural setting is rarer than previously believed, and it arises from unique causes specific to the operating room or procedural environment. Circulatory crisis and cardiac arrest in this setting are usually managed by practitioners who are familiar with the patient, knowledgeable of the patient’s medical condition, and familiar with the details of their procedure, which allows them to intervene in a directed, effective, and timely manner. Management of perioperative crisis is predicated on expert opinion and an understanding of a distinct physiologic milieu.

Additional Reading: McEvoy MD, et al. Cardiac arrest in the operating room: part 2: special situations in the perioperative period. Anesthesia & Analgesia. 2018 Mar;126(3):889-903. doi: 1213/ANE.0000000000002595