Cardiac arrest occurs when the heart is unable to provide sufficient blood flow to oxygenate the heart and the brain. The heart may or may not have some remaining electrical or mechanical activity, but it is insufficient to produce blood flow or a blood pressure. The victim will lose consciousness and stop breathing normally. In the early stages of a cardiac arrest, victims may have a seizure or exhibit gasping respiration. A cardiac arrest in the perioperative setting is a critical event that will require the coordinated efforts of a team to give the patient the best chance to survive. The anesthesia technician is a critical member of that team and must be prepared to respond to a “code.” During a resuscitation, the anesthesia technician must know what roles he or she can play, what the priorities of the resuscitation are, and what equipment or support the resuscitation team will require.

Health care providers may call for assistance or even call a full code when a patient’s condition is deteriorating. Even though these patients have not yet suffered a cardiac arrest, the providers are concerned enough that team members should respond as if a cardiac arrest is imminent. Initial team priorities include the following:

Because there are multiple causes of cardiac arrest in the perioperative setting, the specific equipment and tasks that need to be performed will vary. Despite this, the initial goals of the resuscitation will be to establish circulation with effective chest compressions, apply the defibrillator as soon as possible, deliver shock if appropriate, and establish adequate ventilation. In order to help resuscitation teams perform critical tasks during a cardiac arrest, the American Heart Association has established guidelines for basic life support (BLS) and advanced cardiac life support (ACLS). Resuscitation teams will generally be following these guidelines in the early stages of a cardiac arrest (see Chapter 59). Once a “code” has been called, initial team priorities include the following:

Once the initial resuscitation steps are underway, the priority will turn to determining the underlying cause of the cardiac arrest and attempting to treat appropriately. Depending upon the presumed underlying cause of the cardiac arrest, different procedures or equipment may become a priority. Situations to consider include the following: