CARDIAC ARREST

See Advanced Cardiac Life Support Algorithm in this series
See ILCOR-agreed 2005 Australian Resuscitation Council Life
                               Support Algorithms
      click on " Guidelines" in the left hand column, then
                     - Basic Life Support Flow Chart, or
                     - Adult Cardiorespiratory Flow Chart, or
                     - Paediatric Cardiorespiratory Flow Chart
                       (you will need Adobe Acrobat for these)
See 2004 UK Resuscitation Council Newborn Life Support Algorithm
                       (you will need Adobe Acrobat for this)

PRECIPITATING FACTORS

Pre-existing disease states (1)
     Cardiac
     Respiratory
     Renal
Consequent upon surgical manoeuvres (2)
Error or fault in anaesthetic technique
     Inadequate ventilation
     Essential monitoring not in use (3)
Drug problems (4)
     Overdose (e.g. opioids)
     Induction/reversal drugs
     Anaphylaxis
     Wrong route

EMERGENCY MANAGEMENT

Call for help
Complete COVER ABCD - A SWIFT CHECK
Inform the surgeon
Stop surgery/blood loss
Place patient supine and expose the chest

Praecordial thump (in witnessed or monitored adult arrest only)/external cardiac compression
Australian Resuscitation Council Life support algorithms
Intubate and ventilate with 100% oxygen
ECG, for rhythm clues (5)
Delegate tasks

FURTHER CARE

Confirm and correct the cause
Ensure correct adrenaline dosage (6)
If anaphylaxis go to Anaphylaxis
If septicaemia go to Septicaemia
Correct/prevent hypothermia
Arrange admission to ICU
Accurately document events as soon as possible
See - After the Crisis

NOTES:
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Of the 129 cardiac arrests reported to AIMS, there were 25 fatalities. Of these 129 reports:
     30% occurred outside the operating room;
     11% occurred in the recovery ward;
     6% occurred in the induction room;
     Bradycardia and asystole predominated.
(1) Pre-existing disease was judged to be the sole contributing factor in 23%, and was one of several contributing factors in another 40%
(2) 22% of arrests were directly associated with surgical manoeuvres:
     CO2 insufflation
     autonomic stimulation
     femoral prostheses
(3) Essential monitoring: disconnect alarms, circuit oxygen analyser, pulse oximetry, capnography, spirometry, circuit pressure.
(4) Arrests were closely associated with drug injection in 25% of cases:
     Induction drugs 10%
     Anaphylaxis 8%
(5) Bradycardia 23%
     Asystole 22%,
     Tachycardia/VT/VF 14%
(6) Adrenaline: Adults 1 mg IV bolus slowly
                       Paediatrics initially 0.01 mg/kg IV/intra osseous bolus, up to 0.1 mg/kg;
                                        OR 0.1 mg/kg, either intra-orally or via ETT.

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