Advanced life support - NYSORA

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Advanced life support

Learning objectives

  • Recognize anesthetic complications associated with cardiac arrest
  • Recognize cardiac arrest
  • Treat cardiac arrest associated with anesthesia


  • Advanced life support is a set of life-saving protocols and skills that extend basic life support to further support the circulation and provide an open airway and adequate ventilation (breathing)
  • Is used to provide urgent treatment for cardiac emergencies such as cardiac arrest, stroke, myocardial infarction, and other conditions
  • Should only be performed by paramedics and healthcare providers who have undergone more extensive training

Signs of cardiac arrest

  • ECG with pulseless rhythm
    • Ventricular tachycardia
    • Ventricular fibrillation
    • Severe bradycardia
    • Asystole
  • Loss of:
    • Carotid pulse > 10 seconds
    • End-tidal CO2 on capnograph
    • Arterial line tracing
    • Pulse oximeter signal

Anesthetic complications associated with perioperative cardiac arrest

Management of cardiac arrest associated with anesthesia

advanced life support, tracheal intubation, 100% O2, atropine, isprenaline, adrenaline, transcutaenous pacing, bradycardia, tachycardia, adenosine, cardioversion, CPR, epinephrine, vasopressin, assess rhythm, shockable, asystole, chest compressions, spontaneous circulation, amiodarone

Post resuscitation care

  • Apply invasive monitoring
  • Finalize surgical plan and transport patient to ICU
  • Perform a full history and examination
  • Consider therapeutic hypothermia

Keep in mind

  • Defibrillation is only possible if shockable rhythm (VFIB, VTACH) occurs
  • Bradycardia and hypotension under general anesthesia are relatively common
  • Cardiac arrest in the peri-operative setting is relatively rare and knowing when to initiate CPR can be difficult
  • CPR should be established immediately and treatment will depend on the rhythm seen by EKG monitoring

Suggested reading

  • Soar J, Böttiger BW, Carli P, et al. European Resuscitation Council Guidelines 2021: Adult advanced life support [published correction appears in Resuscitation. 2021 Oct;167:105-106]. Resuscitation. 2021;161:115-151.
  • Moitra VK, Einav S, Thies KC, et al. Cardiac Arrest in the Operating Room: Resuscitation and Management for the Anesthesiologist: Part 1. Anesth Analg. 2018;126(3):876-888.
  • Pollard BJ, Kitchen, G. Handbook of Clinical Anaesthesia. Fourth Edition. CRC Press. 2018. 978-1-4987-6289-2.
  • McEvoy MD, Thies KC, Einav S, et al. Cardiac Arrest in the Operating Room: Part 2-Special Situations in the Perioperative Period [published correction appears in Anesth Analg. 2018 May;126(5):1797]. Anesth Analg. 2018;126(3):889-903.
  • Moitra VK, Gabrielli A, Maccioli GA, O’Connor MF. Anesthesia advanced circulatory life support. Can J Anaesth. 2012 Jun;59(6):586-603. doi: 10.1007/s12630-012-9699-3.

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