Essentials of Cardiac Surgical Resuscitation (ECSR)

Q&A

Question: What energy level is recommended for external defibrillation in a cardiac surgical arrest?

The Society of Thoracic Surgeons 2017 Expert Consensus document1 states that three sequential shocks should be given without intervening massage, at energy levels of 120-200 joules, per manufacturer recommendations. In the absence of specific recommendations, the American Heart Association2 states “the maximum dose setting for that device may be considered.” Many surgeons prefer using the maximum energy level (200 joules) for all attempts. This should be discussed and clarified with your team, and included in internal policies and protocols.

 

References:

  1. Dunning J, Levine A, Ley SJ, et al. The Society of Thoracic Surgeons expert consensus for the resuscitation of patients who arrest after cardiac surgery. Ann Thorac Surg 2017;103:1005-1020. http://dx.doi.org/10.1016/j.athoracsur.2016.10.033

Panchal AR, Bartos JA, Cabanas JG, et al. Part 3: Adult basic and advanced life support, 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020; 142(suppl2):S366-S468. Doi:10.1161/CIR.0000000000000916