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Cardiac Arrest in the Operating Room: Resuscitation and Management for the Anesthesiologist Part 1

Moitra, Vivek K., MD*; Einav, Sharon, MD; Thies, Karl-Christian, MD; Nunnally, Mark E., MD§; Gabrielli, Andrea, MD; Maccioli, Gerald A., MD; Weinberg, Guy, MD#; Banerjee, Arna, MD**; Ruetzler, Kurt, MD††; Dobson, Gregory, MD‡‡; McEvoy, Matthew D., MD**; O’Connor, Michael F., MD, FCCM§§

doi: 10.1213/ANE.0000000000002596
Critical Care and Resuscitation: Narrative Review Article

Cardiac arrest in the operating room and procedural areas has a different spectrum of causes (ie, hypovolemia, gas embolism, and hyperkalemia), and rapid and appropriate evaluation and management of these causes require modification of traditional cardiac arrest algorithms. There is a small but growing body of literature describing the incidence, causes, treatments, and outcomes of circulatory crisis and perioperative cardiac arrest. These events are almost always witnessed, frequently known, and involve rescuer providers with knowledge of the patient and their procedure. In this setting, there can be formulation of a differential diagnosis and a directed intervention that treats the likely underlying cause(s) of the crisis while concurrently managing the crisis itself. Management of cardiac arrest of the perioperative patient is predicated on expert opinion, physiologic rationale, and an understanding of the context in which these events occur. Resuscitation algorithms should consider the evaluation and management of these causes of crisis in the perioperative setting.

From the *Columbia University, New York, New York

Shaare Zedek Medical Center, Jerusalem, Israel

Birmingham Children’s Hospital, Birmingham, United Kingdom

§New York University, New York, New York

University of Pennsylvania, Philadelphia, Pennsylvania

Envision Healthcare, Plantation, Florida

#The University of Illinois at Chicago, Chicago, Illinois

**Vanderbilt University, Nashville, Tennessee

††Cleveland Clinic, Cleveland, Ohio

‡‡Dalhousie University, Nova Scotia, Canada

§§University of Chicago, Chicago, Illinois.

Published ahead of print November 10, 2017.

Accepted for publication September 8, 2017.

K.-C. Thies is currently affiliated with the Department of Anesthesiology, University Medical Center Greifswald, Ferdinand-Sauerbruch-Straße, Greifswald, Germany.

Funding: This manuscript was developed from previous iterations on behalf of the American Society of Anesthesiologists (ASA) and the Society of Critical Care Anesthesiologists. Portions of this manuscript appear verbatim and are used with the permission of the ASA.

Conflicts of Interest: See Disclosures at the end of the article.

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Address correspondence to Vivek K. Moitra, MD, Department of Anesthesiology, PH 527-B, College of Physicians & Surgeons of Columbia University, 630 West 168th St, New York NY 10032. Address e-mail to vm2161@cumc.columbia.edu.

© 2018 International Anesthesia Research Society
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