Cardiac arrest in the operating room requiring prolonged resuscitation

• Published in: Canadian journal of anesthesia 2012-06, Vol.59 (6), p.578-585
• Main Authors: Charapov, Ilia, Eipe, Naveen
• Format: Article
• Language: English
• Subjects: Anesthesia; Anesthesia, General - methods; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology; Biological and medical sciences; Bowel disease; Cardiac arrest; Cardiology; Cardiopulmonary resuscitation; Cardiopulmonary Resuscitation - methods; Case reports; Case Reports/Case Series; CPR; Critical Care Medicine; Electric Countershock - methods; Electrocardiography; Emergency Treatment; Follow-Up Studies; General anesthesia; Heart Arrest - therapy; Humans; Intensive; Intraoperative Complications; Laparotomy; Laparotomy - methods; Lifesaving; Male; Medical personnel; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Pain Medicine; Patients; Pediatrics; Pneumology/Respiratory System; Surgery; Time Factors; Treatment Outcome
• ISSN: 0832-610X; 1496-8975
• DOI: 10.1007/s12630-012-9698-4

Purpose Prolonged cardiopulmonary resuscitation (CPR) is often associated with limited success and poor long-term outcomes. The purpose of this report is to present the case of a patient who suffered an unanticipated cardiac arrest in the operating room and survived following a prolonged period of CPR. Clinical features A previously healthy 53-yr-old male with inflammatory bowel disease was diagnosed with a perforated bowel and underwent emergency exploratory laparotomy under general anesthesia. Approximately two hours after induction of anesthesia, the patient experienced cardiac arrest, and for 55 min, he underwent CPR and defibrillation according to the Advanced Cardiac Life Support (ACLS) protocols. As the decision to terminate CPR was being considered, a return of spontaneous circulation was detected 56 min after the onset of cardiac arrest. The patient survived with no major organ failure or adverse neurological outcome. No definitive cause of cardiac arrest was diagnosed in the postoperative period. At the follow-up 14 months after the event, the patient had returned to the pre-arrest level of functioning. The results of our literature search showed that no upper limit for the duration of CPR has been defined. Good outcomes after prolonged CPR depend on the patient’s pre-arrest condition and the etiology of the cardiac arrest. Conclusion Perioperative cardiac arrests are rare events, and there is little evidence to suggest an upper limit for the duration of resuscitation. Unknown etiologies and the presence of good patient predictors may support the continuation of prolonged CPR with good outcomes.