1
|
Karcher C, Jurisevic C, Southwood T, McCormack D, Rogers A, Levine A, Dunning J. The Australasian ANZSCTS/ANZICS guidelines on cardiothoracic advanced life support (CALS-ANZ). CRIT CARE RESUSC 2022; 24:218-223. [PMID: 38046213 PMCID: PMC10692601 DOI: 10.51893/2022.3.sa3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Christian Karcher
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
- University of Melbourne, Melbourne, VIC, Australia
| | - Craig Jurisevic
- Department of Cardiothoracic Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Tim Southwood
- Department of Intensive Care, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | | | - Amy Rogers
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Adrian Levine
- Department of Cardiothoracic Surgery and Anaesthesia, University of North Staffordshire, Stoke-on-Trent, UK
| | - Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| |
Collapse
|
2
|
Implementing Cardiac Surgical Unit-Advanced Life Support Through Simulation-Based Learning: A Quality Improvement Project. Dimens Crit Care Nurs 2021; 39:180-193. [PMID: 32467400 DOI: 10.1097/dcc.0000000000000425] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The European Association for Cardio Thoracic Surgery and the Society of Thoracic Surgeons endorse Cardiac Surgical Unit-Advanced Life Support, a protocol designed specifically for cardiothoracic surgical patients who suffer postoperative cardiac arrests. To enhance patient outcomes and to reduce death rates, cardiothoracic intensive care unit nurses must be able to perform the protocol with confidence, proficiency, and without delays. To this end, simulation-based learning (SBL) is a pedagogical method ideal for optimized learning. OBJECTIVES This quality improvement project was designed to implement a post-cardiac surgery resuscitation protocol in a nonacademic, community medical center to enhance nurse knowledge, confidence, and proficiency for optimal patient outcomes. METHODS The Cardiac Surgical Unit-Advanced Life Support is an evidence-based resuscitation protocol that was implemented using didactic, hands-on training, and SBL. It was evaluated using knowledge surveys, comparisons in nurse confidence and performance measures, and patient outcomes data. RESULTS Nurses' knowledge gains (ie, mean test scores) on our test were statistically significant between 3 time points (F2,60 = 81.204, P < .001). Knowledge significantly increased from pre-education to immediate post-education (P < .001), but declined from immediate post-education to 3-month post-education assessments (P < .001); however, the 3-month post knowledge mean was still higher than the pre-education knowledge mean (P < .001). Nurses were confident in their ability to apply the protocol, although results failed to show a correlation between confidence and performance ability. Statistical significance for delay in cardiopulmonary resuscitation was found between pre- and post-nursing education patient cardiac arrest events (P = .05). CONCLUSIONS Didactic and hands-on learning supported knowledge retention over time for cardiothoracic surgical intensive care unit nurses. Improving self-confidence and the application of an unfamiliar resuscitation protocol through SBL and any impact a training program has on patient outcomes will require ongoing practice and more evaluation.
Collapse
|
3
|
Cardiopulmonary arrest after cardiac surgery: A retrospective cohort of 142 patients with nine year follow up. Heart Lung 2021; 50:382-385. [PMID: 33621835 DOI: 10.1016/j.hrtlng.2021.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 12/27/2020] [Accepted: 01/25/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although the techniques and perioperative management in modern cardiac surgeries has improved, and mortality and morbidity have decreased dramatically, postoperative cardiac arrest after heart surgery (POCHS) is a life-threatening condition that should be assessed and managed precisely. OBJECTIVE To determine the mortality rate and causes of death in postoperative cardiac arrest after heart surgery (POCHS). METHODS A total of 3342 patients underwent cardiac surgery from 2010 to 2018 in Isfahan, Iran .142 of them experienced POCHS . POCHS patients were investigated for characteristics, causes of cardiopulmonary arrest, first-line treatment, and mortality. These items were compared between survived and deceased patients to find possible prognostic factors. RESULTS The incidence rate of cardiac arrest was 4.2% (142 ones from total of 3342). Success rate of cardiac arrest is 28.8% (41 from 142). Bradycardia was the most common cause of cardiorespiratory arrest (37.3%), followed by cardiogenic shock (30.3%) and ventricular fibrillation (23.2%). Younger patients (58±11.5 versus 62.9±11.3) and those who developed cardiopulmonary arrest due to ventricular fibrillation (42.4% versus 22.2%), bradycardia (21.2% versus 8.8%), and apnea (15.1% versus 6.6%) were more likely to survive, while, those with shock had the worst prognosis (P<0.05). The best response to resuscitation was found among those treated with defibrillator plus ECM (External Cardiac Massage) as compared to the other approaches (P-value=0.003). CONCLUSION Based on the current report, CPR success was found in 28.6% among whom respiratory etiology led to better outcomes than cardiac etiology. The second cause of cardiac arrest is ventricular fibrillation which immediate defibrillation has the best outcome. The highest numerical success in POCHS is combination of ECM with defibrillator.
Collapse
|
4
|
Panchal AR, Bartos JA, Cabañas JG, Donnino MW, Drennan IR, Hirsch KG, Kudenchuk PJ, Kurz MC, Lavonas EJ, Morley PT, O’Neil BJ, Peberdy MA, Rittenberger JC, Rodriguez AJ, Sawyer KN, Berg KM, Arafeh J, Benoit JL, Chase M, Fernandez A, de Paiva EF, Fischberg BL, Flores GE, Fromm P, Gazmuri R, Gibson BC, Hoadley T, Hsu CH, Issa M, Kessler A, Link MS, Magid DJ, Marrill K, Nicholson T, Ornato JP, Pacheco G, Parr M, Pawar R, Jaxton J, Perman SM, Pribble J, Robinett D, Rolston D, Sasson C, Satyapriya SV, Sharkey T, Soar J, Torman D, Von Schweinitz B, Uzendu A, Zelop CM, Magid DJ. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2020; 142:S366-S468. [DOI: 10.1161/cir.0000000000000916] [Citation(s) in RCA: 371] [Impact Index Per Article: 92.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
5
|
Abstract
Creating nurse-driven protocols empower nurses to practice at the top of their scope and provide early interventions. This article describes the development and implementation of an evidence-based, nurse-driven resuscitation protocol for cardiac surgical patients who suffer cardiac arrest using a theoretical framework and leadership-driven process. Readers will gain knowledge of the collaborative process required to develop and implement a complex practice change. Process measures, outcomes, and lessons learned are presented.
Collapse
Affiliation(s)
- Melanie Roberts
- Author Affiliations: Critical Care Clinical Nurse Specialist (Dr Roberts) and Cardiothoracic Surgery Nurse Practitioner Supervisor (Ms Miller), UCHealth Medical Center of the Rockies, Loveland, Colorado
| | | |
Collapse
|
6
|
Michaelis P, Leone RJ. Cardiac Arrest After Cardiac Surgery: An Evidence-Based Resuscitation Protocol. Crit Care Nurse 2019; 39:15-25. [DOI: 10.4037/ccn2019309] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
More than 250 000 cardiac surgical procedures are performed annually in the United States. Postoperative cardiac arrest rates range from 0.7% to 5.2%. This article reviews current evidence for cardiac arrest resuscitation after cardiac surgery. The evaluation included resuscitation guidelines and 22 studies identified through a MEDLINE search. Evidence-based resuscitation differs from advanced cardiovascular life support guidelines. European Resuscitation Council guidelines include correcting reversible causes of arrest, applying defibrillation/pacing before external cardiopulmonary resuscitation, resternotomy within 5 minutes if electrical therapies fail, and restricting epinephrine use to avoid rebound hypertension. A 2017 Society of Thoracic Surgeons protocol derived from European Resuscitation Council guidelines is now standard of care in the United States. Evidence-based practices can improve survival and reduce resternotomy rates. This article describes the clinical implementation of the Society of Thoracic Surgeons guidelines.
Collapse
Affiliation(s)
| | - Richard J. Leone
- Richard Leone is a cardiothoracic surgeon, Skagit Regional Health, Mount Vernon, and Kadlec Regional Medical Center, Richland, Washington
| |
Collapse
|
7
|
Komatsu R, Karimi N, Zimmerman NM, Sessler DI, Bashour CA, Soltesz EG, Turan A. Biochemically diagnosed hypothyroidism and postoperative complications after cardiac surgery: a retrospective cohort analysis. J Anesth 2018; 32:663-672. [DOI: 10.1007/s00540-018-2533-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 07/11/2018] [Indexed: 10/28/2022]
|
8
|
Montgomery ML, Oloomi M, El-Eshmawi A, Adams DH. Electrical Storm After Coronary Artery Bypass Grafting: Diagnosing and Treating the Trigger. J Cardiothorac Vasc Anesth 2018; 33:497-500. [PMID: 29548904 DOI: 10.1053/j.jvca.2018.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Indexed: 01/10/2023]
Affiliation(s)
| | - Mehdi Oloomi
- Department of Anesthesiology, Mount Sinai Medical Center, New York, NY
| | - Ahmed El-Eshmawi
- Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, NY
| | - David H Adams
- Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, NY
| |
Collapse
|
9
|
Pilarczyk K, Trummer G, Haake N, Markewitz A. Neue Leitlinien zur kardiopulmonalen Reanimation und ihre Implikationen für die herzchirurgische Intensivmedizin. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2016. [DOI: 10.1007/s00398-016-0105-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
10
|
Vakil K, Kealhofer JV, Alraies MC, Garcia S, McFalls EO, Kelly RF, Ward HB, Adabag S. Long-Term Outcomes of Patients Who Had Cardiac Arrest After Cardiac Operations. Ann Thorac Surg 2016; 102:512-7. [DOI: 10.1016/j.athoracsur.2016.01.092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 01/17/2016] [Accepted: 01/28/2016] [Indexed: 10/21/2022]
|
11
|
Yu J, Brown D, Kodner IJ, Ray S. Looking beyond the crystal ball: An ethical dilemma in advance directive implementation in multidisciplinary patient care. Surgery 2015; 158:1389-94. [DOI: 10.1016/j.surg.2015.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
12
|
Scherner M, Madershahian N, Strauch JT, Wippermann J, Wahlers T. Transapical Valve Implantation and Resuscitation: Risk of Valve Destruction. Ann Thorac Surg 2011; 92:1909-10. [DOI: 10.1016/j.athoracsur.2011.05.044] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Revised: 05/05/2011] [Accepted: 05/13/2011] [Indexed: 10/15/2022]
|
13
|
Deakin CD, Morrison LJ, Morley PT, Callaway CW, Kerber RE, Kronick SL, Lavonas EJ, Link MS, Neumar RW, Otto CW, Parr M, Shuster M, Sunde K, Peberdy MA, Tang W, Hoek TLV, Böttiger BW, Drajer S, Lim SH, Nolan JP. Part 8: Advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2011; 81 Suppl 1:e93-e174. [PMID: 20956032 DOI: 10.1016/j.resuscitation.2010.08.027] [Citation(s) in RCA: 167] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
|
14
|
Vanden Hoek TL, Morrison LJ, Shuster M, Donnino M, Sinz E, Lavonas EJ, Jeejeebhoy FM, Gabrielli A. Part 12: cardiac arrest in special situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010; 122:S829-61. [PMID: 20956228 DOI: 10.1161/circulationaha.110.971069] [Citation(s) in RCA: 392] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
15
|
Morrison LJ, Deakin CD, Morley PT, Callaway CW, Kerber RE, Kronick SL, Lavonas EJ, Link MS, Neumar RW, Otto CW, Parr M, Shuster M, Sunde K, Peberdy MA, Tang W, Hoek TLV, Böttiger BW, Drajer S, Lim SH, Nolan JP, Adrie C, Alhelail M, Battu P, Behringer W, Berkow L, Bernstein RA, Bhayani SS, Bigham B, Boyd J, Brenner B, Bruder E, Brugger H, Cash IL, Castrén M, Cocchi M, Comadira G, Crewdson K, Czekajlo MS, Davies SR, Dhindsa H, Diercks D, Dine CJ, Dioszeghy C, Donnino M, Dunning J, El Sanadi N, Farley H, Fenici P, Feeser VR, Foster JA, Friberg H, Fries M, Garcia-Vega FJ, Geocadin RG, Georgiou M, Ghuman J, Givens M, Graham C, Greer DM, Halperin HR, Hanson A, Holzer M, Hunt EA, Ishikawa M, Ioannides M, Jeejeebhoy FM, Jennings PA, Kano H, Kern KB, Kette F, Kudenchuk PJ, Kupas D, La Torre G, Larabee TM, Leary M, Litell J, Little CM, Lobel D, Mader TJ, McCarthy JJ, McCrory MC, Menegazzi JJ, Meurer WJ, Middleton PM, Mottram AR, Navarese EP, Nguyen T, Ong M, Padkin A, Ferreira de Paiva E, Passman RS, Pellis T, Picard JJ, Prout R, Pytte M, Reid RD, Rittenberger J, Ross W, Rubertsson S, Rundgren M, Russo SG, Sakamoto T, Sandroni C, Sanna T, Sato T, Sattur S, Scapigliati A, Schilling R, Seppelt I, Severyn FA, Shepherd G, Shih RD, Skrifvars M, Soar J, Tada K, Tararan S, Torbey M, Weinstock J, Wenzel V, Wiese CH, Wu D, Zelop CM, Zideman D, Zimmerman JL. Part 8: Advanced Life Support. Circulation 2010; 122:S345-421. [DOI: 10.1161/circulationaha.110.971051] [Citation(s) in RCA: 250] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
16
|
Invited Commentary. Ann Thorac Surg 2009; 88:68-9. [DOI: 10.1016/j.athoracsur.2009.04.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2009] [Revised: 04/13/2009] [Accepted: 04/21/2009] [Indexed: 11/19/2022]
|