From the Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee.
Department of Anesthesiology, University Medical Centre Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany.
Anesth Analg. 2018 Mar;126(3):889-903. doi: 10.1213/ANE.0000000000002595.
As noted in part 1 of this series, periprocedural cardiac arrest (PPCA) can differ greatly in etiology and treatment from what is described by the American Heart Association advanced cardiac life support algorithms, which were largely developed for use in out-of-hospital cardiac arrest and in-hospital cardiac arrest outside of the perioperative space. Specifically, there are several life-threatening causes of PPCA of which the management should be within the skill set of all anesthesiologists. However, previous research has demonstrated that continued review and training in the management of these scenarios is greatly needed and is also associated with improved delivery of care and outcomes during PPCA. There is a growing body of literature describing the incidence, causes, treatment, and outcomes of common causes of PPCA (eg, malignant hyperthermia, massive trauma, and local anesthetic systemic toxicity) and the need for a better awareness of these topics within the anesthesiology community at large. As noted in part 1 of this series, these events are always witnessed by a member of the perioperative team, frequently anticipated, and involve rescuer-providers with knowledge of the patient and the procedure they are undergoing or have had. Formulation of an appropriate differential diagnosis and rapid application of targeted interventions are critical for good patient outcome. Resuscitation algorithms that include the evaluation and management of common causes leading to cardiac in the perioperative setting are presented. Practicing anesthesiologists need a working knowledge of these algorithms to maximize good outcomes.
正如本系列第 1 部分所述，围术期心搏骤停（PPCA）的病因和治疗方法与美国心脏协会高级心脏生命支持算法有很大不同，后者主要是为院外心脏骤停和手术室外的院内心脏骤停开发的。具体来说，有几种危及生命的 PPCA 原因，其管理应在所有麻醉师的技能范围内。然而，先前的研究表明，这些情况下的管理需要不断审查和培训，这也与改善 PPCA 期间的护理和结果相关。越来越多的文献描述了常见 PPCA 原因（例如恶性高热、严重创伤和局部麻醉药全身毒性）的发生率、原因、治疗和结果，以及在整个麻醉学界更广泛地提高对这些主题的认识的必要性。如本系列第 1 部分所述，这些事件总是由围手术期团队的成员见证，经常可以预见，涉及了解患者及其正在接受或已经接受的手术的急救提供者。制定适当的鉴别诊断并迅速应用针对性干预措施对于患者的良好预后至关重要。提出了包括评估和管理围手术期导致心脏骤停的常见原因的复苏算法。执业麻醉师需要了解这些算法，以最大限度地提高良好的结果。
