Ley S Jill
California Pacific Medical Center, San Francisco, CA, USA
Semin Cardiothorac Vasc Anesth. 2015 Jun;19(2):87-94. doi: 10.1177/1089253214568529.
Perioperative arrest occurs in thousands of cardiac surgical patients annually, yet standard resuscitation methods are ineffective or potentially harmful. These "high risk, low volume" events typically occur in well-monitored patients in the highly specialized environment of the operating room or intensive care unit, with a short list of likely causes of arrest, making a protocolized approach to management feasible and desirable. An evidence-based guideline for resuscitation specific to the cardiac surgical patient was first published by Dunning et al in 2009 and adopted by the European Resuscitation Council the following year. It emphasizes important deviations from advanced cardiac life support, including immediate defibrillation or pacing of arrhythmias before external compressions, if feasible within 1 minute, and avoidance of epinephrine due to potential rebound hypertension. In standard fashion, the rapid exclusion of reversible causes of arrest is followed by chest reopening within 5 minutes. This approach is now standard of care in most European countries and is under review for use in the United States by the Society of Thoracic Surgeons. The anesthesiologist, as either team leader or participant, plays a critical role in optimally managing arrests after cardiac surgery. Their familiarity with this new standard is essential to optimal patient outcomes.
每年有成千上万的心脏外科手术患者在围手术期发生心脏骤停，然而标准的复苏方法却无效或可能有害。这些“高风险、低发生率”的事件通常发生在手术室或重症监护病房这种监控严密的高度专业化环境中的患者身上，心脏骤停的可能原因有限，这使得采用规范化的管理方法既可行又可取。邓宁等人于2009年首次发表了针对心脏外科手术患者的基于证据的复苏指南，次年被欧洲复苏委员会采用。该指南强调了与高级心脏生命支持的重要差异，包括在可行的情况下，若能在1分钟内进行除颤或对心律失常进行起搏，则在进行胸外按压之前先进行这些操作，以及由于可能出现反弹性高血压而避免使用肾上腺素。按照标准方式，在迅速排除心脏骤停的可逆原因后，应在5分钟内重新打开胸腔。这种方法现在在大多数欧洲国家已成为标准治疗方法，美国胸外科医师协会正在对其在美国的应用进行审查。麻醉医生作为团队领导者或参与者，在心脏手术后的心脏骤停优化管理中起着关键作用。他们对这一新标准的熟悉程度对于实现最佳患者预后至关重要。
