The new 2010 ERC resuscitation guidelines - Relevance for cardiac surgery patients

Postoperative cardiac arrest has been reported to occur in 0.7 to 2.9% after cardiac surgical procedures and may be related to ventricular fibrillation, major bleeding, cardiac tamponade, (tension) pneumothorax, failure of epicardial pacemaker leads, and surgery specific complications. Recent experimental data show improved resuscitation efficiency (improved coronary blood flow, more effective defibrillation, lower complication and higher survival rates) during open chest conditions and that patients after cardiac surgery benefit from early rethoracotomy if the circulation cannot be restored immediately after a cardiac arrest. Based on these findings, the latest guidelines for Cardiopulmonary Resuscitation published by the European Resuscitation Council (ERC) in 2010 included a detailed chapter on resuscitation of patients with cardiac arrest after cardiac surgery procedures and suggest that, if conventional basic and advanced cardiopulmonary life support fail to achieve hemodynamic stabilization within 5 minutes after arrest, a rethoracotomy shall be performed immediately by any intensive care specialist and that this shall not necessarily be performed in the operation theatre but may also be accomplished bedside on the intensive care unit. The guidelines recommend a dedicated set of surgical instruments for rethoracotomy and that personal treating patients after cardiac surgery needs to be instructed and trained to fulfil rethoracotomy successfully. Intensive care units (ICU) that have adopted these guidelines as standard operating procedures are mostly lead by cardiac surgeons. It is presently unknown whether ICUs driven by anaesthesiologists perform comparably when facing a cardiac arrest.