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eComment: Also in cardiac arrest it is important to think first

Leiden University Medical Center, Cardiothoracic Surgery, 2333 ZA Leiden, The Netherlands

If a patient arrests after cardiac surgery is it acceptable to delay cardiopulmonary resuscitation until you have attempted either defibrillation or pacing?

The question raised in the manuscript of Lockowandt and coworkers is a very important question [1]. In most cases patients after cardiac surgery will be monitored for at least 24 h. Because of this monitoring, if a patient arrests, it will be known if the arrest is due to, for instance, a severe bradycardia or a ventricular fibrillation. These causes can be treated very quickly in an intensive care unit. If pacing in the case of bradycardia or a few attempts of defibrillation in case of ventricular fibrillation are not successful, it is of utmost importance to start resuscitation and reopening of the chest as soon as possible [2]. Also a tension pneumothorax should be recognized in a few seconds in the intensive care unit. Drainage in that case is more successful than external massage. If the patient arrests a few days after cardiac surgery he will be on the ward and probably there will be more delay until it is clear what the arrest is due to. In those cases the nursing staff should start resuscitation while waiting for the doctors on call to arrive.

The resuscitation technique itself needs a warning notice. In our hospital we have seen several patients after an out of hospital resuscitation where a mechanical device had been used for the external cardiac massage. Sternal fractures were not uncommon just as damage to the myocardium and we have even seen esophageal ruptures in patients where the mechanical device was not perfectly adjusted to the patient's body size. The use of these devices in patients with a recently divided sternum will, without any doubt, lead to a number of sternal fragments unsuitable for sternal rewiring and damage to the underlying structures.

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1. Lockowandt U, Levine A, Strang T, Dunning J. If a patient arrests after cardiac surgery is it acceptable to delay cardiopulmonary resuscitation until you have attempted either defibrillation or pacing? Interac CardioVasc Thorac Surg 2008;7:878–887.[Abstract/Free Full Text]
2. Richardson L, Dissanayake A, Dunning J. What cardioversion protocol for ventricular fibrillation should be followed for patients who arrest shortly post-cardiac surgery? Interac CardioVasc Thorac Surg 2007;6:799–805.[Abstract/Free Full Text]

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 Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Jerry Braun Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Versteegh, M. I. Articles by Braun, J. Search for Related Content PubMed PubMed Citation Articles by Versteegh, M. I. Articles by Braun, J. Related Collections Related Article