title: Guideline for resuscitation in cardiac arrest after cardiac surgery.
abstract: The Clinical Guidelines Committee of the European Association for Cardio-Thoracic Surgery provides this professional view on resuscitation in cardiac arrest after cardiac surgery. This document was created using a multimodal methodology for evidence generation including the extrapolation of existing guidelines from the International Liaison Committee on Resuscitation where possible, our own structured literature reviews on issues particular to cardiac surgery, an international survey on resuscitation hosted by CTSNet and manikin simulations of potential protocols. This protocol differs from existing generic guidelines in a number of areas, the most import of which are the following: successful treatment of cardiac arrest after cardiac surgery is a multi-practitioner activity with six key roles that should be allocated and rehearsed on a regular basis; in ventricular fibrillation, three sequential attempts at defibrillation (where immediately available) should precede external cardiac massage; in asystole or extreme bradycardia, pacing (where immediately available) should precede external cardiac massage; where the above measures fail, and in pulseless electrical activity, early resternotomy is advocated; adrenaline should not be routinely given; protocols for excluding reversible airway and breathing complications and for safe emergency resternotomy are given. This guideline is subject to continuous informal review, and when new evidence becomes available.
authors.affiliation: Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK.
authors.forename: Joel
authors.initials: J
authors.lastname: Dunning
authors.forename: Alessandro
authors.initials: A
authors.lastname: Fabbri
authors.forename: Philippe H
authors.initials: PH
authors.lastname: Kolh
authors.forename: Adrian
authors.initials: A
authors.lastname: Levine
authors.forename: Ulf
authors.initials: U
authors.lastname: Lockowandt
authors.forename: Jonathan
authors.initials: J
authors.lastname: Mackay
authors.forename: Alain J
authors.initials: AJ
authors.lastname: Pavie
authors.forename: Tim
authors.initials: T
authors.lastname: Strang
authors.forename: Michael I M
authors.initials: MI
authors.lastname: Versteegh
authors.forename: Samer A M
authors.initials: SA
authors.lastname: Nashef
mesh_terms: D006348:Cardiac Surgical Procedures; D002985:Clinical Protocols; D003422:Critical Care / Q000379:methods; D004554:Electric Countershock; D004837:Epinephrine / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D006323:Heart Arrest / Q000175:diagnosis / Q000628:therapy*; D006336:Heart Massage / Q000379:methods; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy*; D012151:Resuscitation / Q000379:methods*; D013249:Sternum / Q000601:surgery; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D014662:Vasoconstrictor Agents; D004837:Epinephrine