Introduction

Defibrillation, ventilation, pacing and resuscitation are essential components of cardiac surgical care. The 2005 European Resuscitation Council Guidelines report the incidence of resuscitation as 0.7% in the first 24 hours, rising to 1.4% within the first 8 days of cardiac surgery. Overall in-hospital cardiac surgical mortality rates (>3.0%), together with the low incidence of do not attempt resuscitation (DNAR) orders and the high proportion of treatable arrests in this population all suggest a higher true incidence of postoperative resuscitation. The most likely explanation for the discrepancy is that many resuscitation interventions are undertaken in house on the cardiac surgical critical care. As patients undergoing cardiac surgery become older and sicker, the quality of postoperative care and resuscitation will continue to increase in importance. Conventional advanced life support (ALS) guidelines provide a useful framework but require modification, particularly in the cardiac surgical critical care setting. This chapter highlights some of the key differences.

Resuscitation guidelines

Adult basic life support

Maintaining the circulation has been promoted ahead of airway management and breathing in adult basic life support (BLS) guidelines. The traditional ‘ABC’ (airway, breathing, circulation) in the previous BLS algorithm has been replaced by ‘CAB’ (circulation, airway, breathing). Thirty chest compressions should be given before any attempt to deliver rescue breaths. In situations where BLS is undertaken, the recommended ratio of chest compressions to ventilations is now 30:2 for both one- and two-person cardiopulmonary resuscitation (CPR).