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Cardiac Arrest in the Minimally Invasive Cardiac Surgery Patient: Is Conservatism an Aggressive Approach?

  • Brody Wehman
  • Husam H. BalkhyEmail author
Chapter
Part of the Difficult Decisions in Surgery: An Evidence-Based Approach book series (DDSURGERY)

Abstract

Resuscitation of the arresting cardiac surgery patient who has undergone a minimally invasive, sternal-sparing cardiac procedure presents a unique clinical challenge. This chapter reviews the reported incidence of post-operative cardiac arrest and provides recommendations for management of this subset of cardiac surgery patients. We recommend that institutions practicing minimally invasive surgery develop a clear and agreed upon protocol for management of the arresting non-sternotomy cardiac surgery patient. If extracorporeal membrane oxygenation (ECMO) is available, we believe that peripheral venoarterial ECMO should be considered the first-line of intervention in the non-sternotomy patient suffering refractory cardiac arrest. If resuscitation via ECMO is not available, a sternotomy is an acceptable alternative as long as the operating surgeon is available or a trained team is comfortable with performing a fresh sternotomy.

Keywords

Minimally invasive cardiac surgery Cardiac arrest Resuscitation Extracorporeal membrane oxygenation 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Bon Secours Heart and Vascular InstituteRichmondUSA
  2. 2.Department of Surgery, Section of Cardiac and Thoracic SurgeryUniversity of Chicago Medicine and Biological SciencesChicagoUSA

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