Advanced Cardiac Life Support (ACLS) in Operating Room
Advanced cardiac life support was developed as an extension of basic life support. The use of ACLS was originally put in place to manage patients who had the onset of sudden cardiac arrest. It was later used and imported into the hospital setting.
The application of ACLS has been intended for patients who suddenly collapsed or who were found unresponsive.
ACLS remains focused on common cardiac causes of circulatory arrest and also incorporates defibrillation and the use of drugs to restore spontaneous blood flow.
A recent article regarding the use of ACLS in the operating room has come to light. According to recent updates, the goal of resuscitating a patient in the operating room is set up both as a way to resuscitate and to prevent cardiac arrest during the perioperative.
Cardiac arrest in the operating room is distinct because the arrest is almost always witnessed and precipitated causes are mostly known by the medical team in the operating room suite. Compared to other cardiac arrest settings in the community, the response is potentially timelier, focused and can reverse causes such as medication side effects and airway crisis. The medical team who are taking care of patients undergoing surgery know the relative medical history and witness crisis that deteriorates over minutes to hours. Aggressive measures can be taken to support the patient to advert or delay the need for ACLS.
A group of twelve international physician experts in cardiac arrest and resuscitation were put together to come up with a plan for both the causes of cardiac arrest in the operating room and how to best respond in preventing poor outcomes.
Over the past five years, multiple studies have reported increased survivorship after perioperative arrest compared to cardiac arrest in the general community or as inpatient hospital patient.
It has been reported that to rescue a patient from crisis, caregivers must recognize the patient is in crisis and institute effective action. Recognition that a patient is in crisis is more difficult in the periprocedural setting because the patient is sedated or under general anesthesia (precluding adequate monitoring of their mental status); their respiration are often controlled (preventing tachypnea); surgical positioning often frustrates assessment; and large portions of the patient's body are covered with drapes. The failure to rescue is an often-invoked "cause" of cardiac arrest and morbidity/mortality and is generally the product of hindsight bias shaping the devaluation of the care given.
To overcome poor outcomes and death in cardiac arrest in the operating room, escalation of care includes higher levels of monitoring and more advanced supportive measures. Decisions about higher levels of monitoring or evaluation require consideration of the patient's history, current clinical status, anesthetic, and procedure. Almost every unstable patient should be monitored with an arterial line. Central venous access is appropriate when monitoring central venous pressures or venous oxygen saturation which help guide resuscitation. Over the last ten years, medical clinicians have increasingly performed point of care ultrasound in unstable patients to make quick diagnosis and manage a crisis. In short, the corrective measures for clinical progression to shock is to recognize the crisis, call for help, call for defibrillator, hold the anesthesia, confirm airway positioning and functioning, assess oxygen source, administer IV fluids.
The recognition of cardiac arrest in the operating room is more difficult than it might seem. The vast majority of alarms from sensors such as the ECG and pulse oximeter are false alarms. Bradycardia happens relatively frequently in patients undergoing anesthesia and is often associated with hypotension from the combination of anesthesia and little or no procedural stimulation.
Circulatory crisis and cardiac arrest in the operating room are usually managed by the medical team on site who are familiar with the patient, knowledgeable of the patient's medical condition, and familiar with the details of their procedure, which allows him to intervene effectively and timely. Management of perioperative crisis is predicated on expert opinion and an understanding of the distinct physiological milieu.
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