Abstract
Dr. O.P. Yadava, CEO & Chief Cardiac Surgeon, National Heart Institute, New Delhi, India and Editor-in-Chief, Indian Journal of Thoracic and Cardiovascular Surgery in conversation with Dr. Adrian J Levine, Consultant Cardiac Surgeon, University Hospital of the North Midlands, UK.
Supplementary Information
The online version contains supplementary material available at 10.1007/s12055-021-01221-1.
Keywords: Cardiac arrest, CSU-ALS protocol, Post-cardiac surgery, Mortality, Resternotomy, Cardiopulmonary resuscitation
Cardiac Surgical Unit—Advanced Life Support (CSU-ALS) is a protocol for managing post-cardiac surgery cardiac arrest. It essentially addresses the two major differences between a post-cardiac surgery cardiac arrest and a non-surgical cardiac arrest:
The physiological differences between a cardiac arrest in a general medical ward and the one occurring post-cardiac surgery.
The practical matters associated with this cardiac arrest.
Most of these cardiac arrests, following cardiac surgery, have a reversible cause like hypovolaemia, cardiac tamponade, etc. In 60–70% of these situations, normal cardiopulmonary resuscitation (CPR) will not work and thus, resternotomy within 5 min of the arrest is the only thing that will give any reasonable chance of survival [1, 2].
Practically, the post-cardiac surgery patient is highly monitored (thus allowing for immediate recognition of the arrest), surrounded by many skilled clinical practitioners, intubated and in an environment where emergency resternotomy is able to be delivered. These simple practical matters differentiate it from a ‘standard arrest’ and make it mandatory that we change the way we organise clinicians during such an arrest to optimise the efficiency in their decision-making and their ability to carry out resternotomy, if necessary.
North American data shows that the incidence of post-cardiac surgery arrest varies from 3 to 8% and this figure is volume dependant, with smaller centres having higher rates. Across the board, mortality after cardiac arrest is extremely high and varies from 50 to 70%. However, data from units in San Francisco and the UK have shown that with the CSU-ALS protocols, this mortality reduces significantly from 65 to 35%.
The CSU-ALS protocol has been approved by the European Association of Cardio Thoracic Surgery (EACTS) and the Society of Thoracic Surgeons (STS) and a host of other regulatory bodies. It is run as a single day course, with additional mandatory pre-course eLearning, and is a combination of practical simulations and didactic lectures. This learning comes at a cost, but this is significantly subsidised for the developing world. In India, it can be accessed via https://calsindia.mediknit.org.
Supplementary Information
Below is the link to the electronic supplementary material.
Funding
Provided by Indian Association of Cardiovascular and Thoracic Surgery.
Declarations
Consent to participate
Not required.
Conflict of interest
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
References
- 1.Brand J, McDonald A, Dunning J. Management of cardiac arrest following cardiac surgery. BJA Educ. 2018;18:16–22. doi: 10.1016/j.bjae.2017.11.002. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Dunning J, Levine A, Ley SJ, et al. The Society of Thoracic Surgeons expert consensus for the resuscitation of patients who arrest after cardiac surgery. Ann Thorac Surg. 2017;103:1005–20. [DOI] [PubMed]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.