Cardiac Arrest in the Operating Room: Resuscitation and Management for the Anesthesiologist: Part 1

Vivek K. Moitra, MD; Sharon Einav, MD; Karl-Christian Thies, MD; Mark E. Nunnally, MD; Andrea Gabrielli, MD; Gerald A. Maccioli, MD; Guy Weinberg, MD; Arna Banerjee, MD; Kurt Ruetzler, MD; Gregory Dobson, MD; Matthew D. McEvoy, MD; Michael F. O'Connor, MD, FCCM


Anesth Analg. 2018;126(3):876-888. 

In This Article

Causes of Perioperative Cardiac Arrest

The spectrum of causes of circulatory crisis and cardiac arrest may be very different than anywhere else inside the hospital or outside it. Vagal responses to surgical manipulation, vagotonic anesthetics, sympatholysis from anesthetic agents, β-blockers, and the suppression of cardiac-accelerator fibers arising from T1 to T4 in patients undergoing neuraxial anesthesia are common causes of perioperative bradycardia.[8,9] Hypoxia associated with difficult airway management is a well-recognized cause of cardiac arrest in the operating room.[10–13] Pulseless electrical activity (PEA) from hypovolemia is a common cause of cardiac arrest in hemorrhaging patients in the operating room. The unique and broad differential diagnosis of circulatory collapse in the periprocedural period includes anesthetic conditions such as inhalational and intravenous anesthetic overdose; neuraxial blockade, local anesthetic systemic toxicity, and malignant hyperthermia; respiratory causes such as hypoxemia, auto–positive end-expiratory pressure (PEEP), and bronchospasm; and cardiovascular etiologies such as vasovagal and oculocardiac reflexes, hypovolemic shock, air embolism, increased intraabdominal pressure, transfusion and anaphylactic reactions, tension pneumothorax, pacemaker failure, prolonged QT syndrome, and electroconvulsive therapy.[10–13]