Cardiac Surgical Unit Advanced Life Support Protocol Impacts Survival and Functional Recovery After Cardiac Arrest: A Single Institutional Experience

M. P. Weber¹, B. Smith¹, M. F. Dawson², S. W.W.. Noona¹, S. D. Young¹, M. El Moheb¹, N. Kessler¹, M. Mazzeffi¹, L. Yarboro¹, J. Beller¹, N. Teman^1
1University of Virginia, Charlottesville, Virginia ²UVA Health, Charlottesville, Virginia

Purpose: There is a lack of granular, institutional level data in the literature evaluating outcomes after initiation of Cardiac Surgical Unit-Advanced Life Support (CSU-ALS) protocols. We sought to better characterize the impact of CSU-ALS training and implementation in our own single institutional experience.

Methods: All patients who underwent cardiac surgery at our institution from 2020 to 2024 were identified and linked with their respective STS data. The CSU-ALS protocols and training were officially adopted at our institution on January 1, 2020. CSU-ALS eligibility was defined as adult cardiac surgery patients who experienced cardiac arrest within 10 days of an index procedure involving sternotomy. Additional information regarding the timing of arrest, etiology, presenting rhythm, re-sternotomy, need for extracorporeal membrane oxygenation (ECMO) or dialysis, and functional outcome was collected.

Results: In the post-CSU-ALS training period, 22 patients underwent cardiac arrest and were deemed CSU-ALS eligible. A total of 16 (72.7%) of those patients were resuscitated following the CSU-ALS protocol. Patients who did not receive resuscitation via the protocol typically experienced arrest in the operating room or outside the cardiac surgical units. Out of our CSU-ALS cohort, the most common index procedure was isolated CABG in 6 (37.5%) patients followed by aortic procedures in 4 (25.0%) patients. Pulseless electrical activity was the most common presenting rhythm (n=7, 43.7%), followed by ventricular tachycardia (n=4, 25.0%), asystole (n=3, 18.8%), and ventricular fibrillation (n=2, 6.3%). Additionally, 6 (37.5%) patients were placed on ECMO, and 4 (25.0%) required dialysis. A total of 11 (73.3%) patients survived to discharge with 9 (81.8%) of those survivors fully neurologically intact. Emergent re-sternotomy was performed in 15 (93.8%) cases. In the case without re-sternotomy, ROSC was obtained successfully with initial defibrillation. In the subgroup of cardiac arrests caused by tamponade, bleeding, or hypotension, 4 out of 5 (80%) patients survived to discharge after emergent re-sternotomy.

Conclusion: CSU-ALS protocols facilitate timely defibrillation and effective re-sternotomy, addressing a wide range of clinical presentations and causes of cardiac arrest. These protocols enable high-performing teams to deliver quality resuscitation, resulting in low mortality rates and ensuring good quality of life and functional status for patients.

Identify the source of the funding for this research project: None