Evidence-Based Protocol for Cardiac Surgical Arrest

Q: What are the best ways for nurses and their teams to ensure appropriate care during cardiac surgical arrest?

A: S. Jill Ley, MS, RN, CNS, replies:

Specialized management of cardiac surgical arrest was first recommended in 2017 by the Society of Thoracic Surgeons (STS) for “all care providers and units”¹  and was endorsed by the American Heart Association 3 years later.²  Because external massage is ineffective in promoting cerebral perfusion during tamponade or extreme hypovolemia due to bleeding—conditions often present during cardiac surgical emergencies—basic life support (BLS) is not recommended in this situation. Instead, the STS cardiac surgical resuscitation (CSR) protocol advocates immediate assessment of the rhythm, followed by 3 stacked defibrillations for a shockable rhythm or pacing for a bradyarrhythmia, before beginning compressions if these modalities are available within 1 minute.¹  Because shockable rhythms are present in up to 50% of cardiac surgical arrest cases,...