Cardiac arrest can complicate up to 3% of cardiac surgeries. The etiology can be reversible, such as cardiac tamponade or VF. Already present pacing wires can be used to manage some arrhythmias, such as bradycardias and asystole.

Sternotomy

In the case of cardiac arrest following cardiac surgery, there are conflicting reports about the benefit of repeat sternotomy with internal cardiac compression compared to standard CPR when provided by skilled clinicians. Some studies show benefits, while others are equivocal. However, sternotomy outside of the ICU setting is associated with poor outcomes. If resources are available in the ICU setting, sternotomy and internal compressions are reasonable. (Class IIa, Evidence level B). If these are not available, immediate standard CPR is advised, even if there is a risk of damage to the heart. (Class IIa, Evidence level C). 

Mechanical Support

Cardiopulmonary bypass and extracorporeal membrane oxygenation have been used in patients with refractory post-cardiac surgery arrests. These options are reasonable when other standard therapies have failed and may improve patient outcomes. (Class IIb, Evidence level B).  

Pharmacologic Management

Post cardiac surgery patients are at increased risk of bleeding following rebound hypertension associated with vasopressors. However, there is no research specifying the optimal dose of arrest medications for these groups of patients. At this time, standard doses are generally used in cardiac surgery patients.