Ley S Jill
S. Jill Ley is a clinical nurse specialist in cardiac surgery at California Pacific Medical Center and a clinical professor at the University of California, San Francisco. She is a member of The Society of Thoracic Surgeons' task force developing new resuscitation guidelines for the United States.
Crit Care Nurse. 2015 Apr;35(2):30-7; quiz 38. doi: 10.4037/ccn2015652.
Of the 250 000 patients who undergo major cardiac operations in the United States annually, 0.7% to 2.9% will experience a postoperative cardiac arrest. Although Advanced Cardiac Life Support (ACLS) is the standard approach to management of cardiac arrest in the United States, it has significant limitations in these patients. The European Resuscitation Council (ERC) has endorsed a new guideline specific to resuscitation after cardiac surgery that advises important, evidence-based deviations from ACLS and is under consideration in the United States. The ACLS and ERC recommendations for resuscitation of these patients are contrasted on the basis of the essential components of care. Key to this approach is the rapid elimination of reversible causes of arrest, followed by either defibrillation or pacing (as appropriate) before external cardiac compressions that can damage the sternotomy, cautious use of epinephrine owing to potential rebound hypertension, and prompt resternotomy (within 5 minutes) to promote optimal cerebral perfusion with internal massage, if prior interventions are unsuccessful. These techniques are relatively simple, reproducible, and easily mastered in Cardiac Surgical Unit-Advanced Life Support courses. Resuscitation of patients after heart surgery presents a unique opportunity to achieve high survival rates with key modifications to ACLS that warrant adoption in the United States.
在美国，每年接受心脏大手术的25万名患者中，有0.7%至2.9%会在术后发生心脏骤停。尽管高级心脏生命支持（ACLS）是美国心脏骤停管理的标准方法，但在这些患者中它有显著局限性。欧洲复苏委员会（ERC）认可了一项专门针对心脏手术后复苏的新指南，该指南建议在一些重要方面基于证据偏离ACLS，且在美国正在考虑采用。基于护理的基本要素，对ACLS和ERC关于这些患者复苏的建议进行了对比。这种方法的关键是迅速消除心脏骤停的可逆原因，然后在可能损伤胸骨切开术的胸外按压之前进行除颤或起搏（视情况而定），由于可能出现反弹性高血压要谨慎使用肾上腺素，如果先前的干预措施不成功，应迅速（在5分钟内）再次开胸，通过心脏内按摩促进最佳脑灌注。这些技术相对简单、可重复，并且在心脏外科高级生命支持课程中很容易掌握。心脏手术后患者的复苏提供了一个独特的机会，通过对ACLS进行关键修改来实现高生存率，这些修改值得在美国采用。
