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Avoidance of administration of 1 mg of adrenaline in cardiac arrest after cardiac surgery

Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, UK

Should adrenaline be routinely used by the resuscitation team if a patient suffers a cardiac arrest shortly after cardiac surgery?

Cardiac arrest in the early postoperative period after cardiac surgery is usually rapidly reversible by appropriate treatment of the underlying cause [1]. Excessive hypertension induced by adrenaline following return of spontaneous circulation in this setting may cause catastrophic disruption of surgical anastomoses. The intravenous administration of a relatively low dose of adrenaline in the peri-arrest scenario may have similar consequences. The evidence to support the use of adrenaline in cardiac arrest is weak [2].

The intravenous administration of 1 mg of adrenaline should not be recommended in cardiac arrest after cardiac surgery. Emphasis should instead be given to external cardiac compression, immediate defibrillation, rapid correction of reversible causes and early emergency re-sternotomy if appropriate. The European Resuscitation Council (ERC) should consider changing their guidelines for the resuscitation of patients who suffer cardiac arrest following cardiac surgery [3].

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1. Mackay JH, Powell SJ, Osgathorp J, Rozario CJ. Six-year prospective audit of chest reopening after cardiac arrest. Eur J Cardiothorac Surg 2002;22:421–425.[Abstract/Free Full Text]
2. Tsagkataki M, Levine A, Strang T, Dunning J. Should adrenaline be routinely used by the resuscitation team if a patient suffers a cardiac arrest shortly after cardiac surgery? Interact CardioVasc Thorac Surg 2008;7:457–463.[Abstract/Free Full Text]
3. Nolan JP, Deakin CD, Soar J, Bottiger BW, Smith G. European Resuscitation Council. European Resuscitation Council guidelines for resuscitation 2005. Section 4. Adult advanced life support. Resuscitation 2005;67(1 Suppl):S39–S86.[CrossRef][Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Stephen T. Webb Permission Requests Google Scholar Articles by Webb, S. T. PubMed Articles by Webb, S. T. Related Collections Related Article