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

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.