Cardiac Arrest - Guidelines for Crises in Anaesthesia The probable cause is one or more of: something related to surgery or anaesthesia; the patient’s underlying medical condition; the reason for surgery; equipment failure. The first priority is to start chest compressions, then get help, then find and treat the cause using the guideline. ❶ IMMEDIATE ACTION • Declare “cardiac arrest” to the theatre team AND note time. • Delegate one person (minimum) to chest compressions 100 min-1, depth 5 cm. • Call for help: nearby theatres / emergency bell / senior on-call / dial emergency number. • Call for cardiac arrest trolley. • As soon as possible, delegate task of evaluating potential causes (Box A). ❷ Adequate oxygen delivery • Increase fresh gas flow, give 100% oxygen AND check measured FiO2. • Turn off anaesthetic (inhalational or intravenous). • Check breathing system valves working and system connections intact. • Rapidly confirm ventilator bellows moving or provide manual ventilation. ❸ Airway • Check position of airway device and listen for noise (including larynx and stomach). • Confirm airway device is patent (consider passing suction catheter). • If expired CO2 is absent, presume oesophageal intubation until absolutely excluded. ❹ Breathing • Check chest symmetry, rate, breath sounds, SpO2, measured expired volume, ETCO2. • Evaluate the airway pressure using reservoir bag and APL valve. ❺ Circulation • Check rate and adequacy of chest compressions (visual and ETCO2). • Encourage rotation of personnel performing compressions. • If i.v. access fails or impossible use intraosseous (IO) route. • Check ECG rhythm for no more than 5 seconds. • Follow Resuscitation Council (UK) and ERC Guidelines. • See Boxes B and C for reminders about drugs and defibrillation. ❻ Systematically evaluate potential underlying problems and act accordingly (Box A). ❼ If there is return of spontaneous circulation, re-establish anaesthesia. POTENTIAL CAUSES 4 H’s, 4 T’s: Hypoxia (→ 2-2) Hypovolaemia Hypo/hyperkalaemia Hypothermia Tamponade (→ 3-9) Thrombosis (→3-5) Toxins Tension pneumothorax Specific peri-operative problems: Vagal tone Drug error Local anaesthetic toxicity (→ 3-10) Acidosis Anaphylaxis (→ 3-1) Embolism, gas/fat/amniotic (→ 3-5) Massive blood loss (→ 3-2) By Association of Anaesthetists @ https://twitter.com/AAGBI Quick Reference Handbook - Guidelines for crises in anaesthesia #CardiacArrest #Checklist #Differential #Anesthesiology #Anesthesia #Intraoperative #Checklist #Diagnosis #Management #Workup
