Intraoperative Cardiac

Arrest
Mark Andrew B. Cruz, MD
 What is Crucial in
Resuscitation?
Early administration of Epinephrine?

Early defibrillation?

Early provision of advanced airway?

Early Recognition

High-Quality CPR
 High Quality CPR
Rate of 100-120 compressions/minute

Allow complete chest recoil

Compressor depth of at least 5 cm in adults

Minimize interruptions

Avoid excessive ventilation

Switch providers every 2 minutes

 Right Rate
Complete Recoil
A rate that is too fast will not allow the heart to refill
with blood, decreasing cardiac output, making
compressions futile.

Sing it with:
TITA/TITO: Stayin’ Alive
MILLENIAL: Macarena
GEN Z: Baby Shark
 Right Depth
‘Gotta push that blood out

If available, AHA recommends the use of a feedback

device
Minimize Interruptions
To maintain adequate Coronary Perfusion Pressure

Interruptions should not be more than 10 seconds!

If not sure of the pulse, continue compressions

 Avoid Excessive
Ventilation
Continue providing physiologic VT (5-7ml/kg)

Rate for patients with advanced airway: 1 breath

every 6 seconds asynchronus with the compressions

Overinflation  Increased intrathoracic pressure 

Decreased venous return  Decreased cardiac
output
Switch providers every
2 minutes
TAO LANG AKO,
NAPAPAGOD DIN
 WHAT IS ADEQUATE?
ETCO2
>10mmHg

Coronary perfusion pressure

Diastolic pressure of >20mmHg in A-line

Central venous oxygenation saturation

Saturation >30%
 Unstable SVT

• Hypotension
• Altered mental status
• Signs of shock
• Ischemic chest discomfort
• Acute heart failure
Synchronized cardioversion- providing shock at a
specific cardiac cycle (Peak of QRS wave)
Synchronization prevents the delivery of shock
during a vulnerable phase of cardiac cycle (T wave)
which could precipitate VF.

Low energy shocks should be delivered to avoid

precipitating VF

Narrow regular: 50-100 J

Ventricular Fibrillation

Give Epinephrine

Give Shock

Give Compressions
Early defibrillation is important

Defibrillation terminates all electrical activity to

allow the normal pacemakers to initiate the electrical
activity

Resume CPR right after delivering shock

Do not stop CPR while waiting for the defibrillator to

charge or while waiting for the equipment to arrive
Dose of shock?
Monophasic: 360J
Biphasic:
120-200 J?

Manufacturer recommendation
If not sure, use the maximum dose
 ROSC
Optimize ventilation and oxygenation
ETCO2 of 35-40 mmHg

Targeted temperature management

Temp 32-36 for 24 hours
Thank you