Cardiothoracic ALS

Background

Information from the Australasian ANZSCTS/ANZICS guidelines on cardiothoracic advanced life support (CALS-ANZ) 2022.

• Most post cardiothoracic surgery arrests occur early
• Many are due to reversible causes e.g. cardiac tamponade/haemorrhage
• The NZSCTS/ANZICS group have published specific resusc. protocols for this group

CALS algorithm

Resternotomy

How to

• Adhesive surgical drape on patient's chest
• Cut skin sutures
• Remove closure wires/plates
• Insert retractor to expose heart
• Remove any clots
• 2 handed internal cardiac massage
• If shockable, internal defib. pads at 20 J

Kit

Notes

• Shortly post-op, external cardiac massage may be delayed for 60 seconds to help ID/Treat reversible causes:
  • Fibrillation
  • Pacing
  • Pericardial tamponade
  • Tension PTX
  • Massive haemorrhage
• Immediate resternotomy considered if <10 days post-op
• Avoid XS adrenaline (use 50-100mG IV instead of 1mg)
• Consider Amiodarone (300mg IV) in refractory VF
• If ROSC occurs before commencing a resternotomy, continue preparing for a resternotomy until the patient is stable
• If ROSC occurs during the resternotomy, remove the sternal closing devices and await the cardiothoracic surgeons

Links

• ANZSCTS/ANZICS (CALS-ANZ). DOI:10.51893/2022.3.SA3