Analysis And Management Of Cardiac Arrest Shortly After Open-heart Surgery

Objective: To assess the incidence of causes precipitating sudden cardiac arrest in cardiac surgery patients during the immediate postoperative period. Offer help for clinical prevention and treatment of sudden cardiac arrest. Methods: Data on all cardiac surgical patients who suffered a sudden cardiac arrest during the first 24 after surgery from May 1994 to March 2003 in our hospital were collected retrospectively. Analysis the causes and treatments of the sudden cardiac arrest. Result: Cardiac arrest occurred in the first 24h after surgery. The case of cardiac arrest include rheumatic heartdisease (58.3%), coronary heart disease (20.8%) and all kinds of congenital heart disease(20.8%). The causes of sudden cardiac arrest include low cardiac output(ll cases), electrolyte disturbance(7 cases), tamponade(3 cases), bleeding(2 cases), unclear cause(l case). Main ways of resuscitation are closed-chest cardiopulmonary resuscitation, artificial respiration, electron-trapping, medication, open-chest cardiopulmonary resuscitation and advanced treatment after resuscitation. Of 1,320 patients undergoing cardiac surgery over nine years, 24 patients(1.81%) had cardiac arrest. Of these, 15 patients (62.5%)were successfully resuscitated. Conclusion: 1.Among various disease, the incidence of cardiac arrest of rheumatic heart disease and coronary heart disease are higher than others. The causes of cardiac arrest are different among these diseases such as low cardiac output, electrolyte disturbance, tamponade and bleeding. The causes of rheumatic heart disease are low cardiac output and electrolyte disturbance. The main cause of coronary heart disease is low cardiac output syndrome. Therefore, we should pay attention to perioperativetherapy of severe rheumatic heart disease. For the coronary heart disease, application of IABP(Intra-aortic balloon Counterpulsation) timely is necessary when drugs such as epinephrine have no use in a coronary heart disease case with low output syndrome. 2.In the first 24 after surgery, we should give emphasis to measurement of electrolyte and reclaim hypokaliemia and hypomagnesemia in time. Bedside UCG is useful in realizing cardiac systolic function and tamponade in time. 3.Survival incidence of cardiac arrest rest with timely and efficiently resuscitation. Closed-chest resuscitation is more useful than artificial respiration in emergency time. The open-chest cardiopulmonary resuscitation may be chose 5-10min after closed-chest cardiopulmonary resuscitation. Repeated standard doses of epinephrine can enhance survival rate. The treatment after resuscitation is necessary for forbidding reappear of cardiac arrest such as balance of electrolyte, anti-arrhythmia treatment, among which cerebral resuscitation is most important.