logo
episode-header-image
Jul 22
15m 40s

#264 Rethinking Resuscitation in the Ope...

Anesthesia Patient Safety Foundation
About this episode

Cardiac arrest in the operating room presents unique challenges that standard Advanced Cardiovascular Life Support (ACLS) protocols simply were not designed to address. This eye-opening exploration with APSF author, Zachary Smith, reveals why traditional resuscitation guidelines fall short when emergencies strike during surgery and anesthesia care.

The dynamics of cardiac arrest differ dramatically in the perioperative environment. While out-of-hospital arrests typically stem from arrhythmic events, OR emergencies often result from hemorrhage, embolism, hypoxemia, or critical drug reactions like malignant hyperthermia or local anesthetic toxicity. These scenarios demand immediate, specialized interventions beyond standard ACLS algorithms.

Physical constraints further complicate matters. What happens when cardiac arrest occurs while a patient is positioned prone, lateral, or in steep Trendelenburg? Traditional compressions become impossible, and emerging research suggests prone CPR might actually be superior in some scenarios. Moreover, the advanced monitoring capabilities in the OR – arterial lines, central venous pressure readings, and echocardiography – provide critical data not incorporated into standard protocols.

The American Society of Anesthesiologists has responded with their Perioperative Resuscitation and Life Support Certificate program, addressing these gaps through specialized training that combines ACLS principles with OR-specific knowledge.  Ready to enhance your skills beyond basic ACLS? Explore the ASA's certificate program to earn patient safety CME credits while gaining life-saving expertise tailored to the unique challenges of the operating room. Your specialized knowledge could make all the difference when seconds count.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/264-rethinking-resuscitation-in-the-operating-room-beyond-acls/

© 2025, The Anesthesia Patient Safety Foundation

Up next
Oct 7
#275 Tracheostomy and Laryngectomy Patient Safety: Bedside Signs, Algorithms, and the Discipline that Prevents Catastrophe
A patient rolls into the OR with a tracheostomy—do you maintain the current tube, intubate orally, or go through the stoma? We break down the decision tree that keeps patients safe, from assessing tract maturity and surgical needs to choosing cuffed vs uncuffed strategies and pla ... Show More
16m 49s
Sep 30
#274 Critical Decision Points in Emergency Tracheostomy Management
Tracheostomy complications occur at an alarming rate, affecting nearly half of all patients during their initial hospitalization. When these emergencies strike, having a systematic approach can make the difference between life and death.We dive deep into the critical steps for ma ... Show More
18m 21s
Sep 23
#273 Breathless Moments: When Premature Babies Need Extra Vigilance
When our smallest patients need anesthesia care, their immature systems present unique challenges that demand specialized knowledge and vigilance. The risk of postoperative apnea in former preterm infants has long been recognized, but the evidence guiding management continues to ... Show More
18m 58s
Recommended Episodes
May 2023
293. ACHD: Interventional Cardiology with Dr. Jamil Aboulhosn and Dr. Joanna Ghobrial – Part 1
CardioNerds (Amit Goyal and Daniel Ambinder), ACHD series co-chairs Dr. Dan Clark and Dr. Josh Saef, and ACHD FIT lead Dr. J.D. Serfas (Duke University) and Cardiology Fellow Dr. Victoria Thomas (Vanderbilt University) join ACHD experts Dr. Jamil Aboulhosn (Professor of Medicine ... Show More
59m 16s
Oct 2024
397. Guidelines: 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure – Question #36 with Dr. Shelley Zieroth
The following question refers to Section 2.2 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. The question is asked by CardioNerds Academy Intern Dr. Adriana Mares, answered first by CardioNerds FIT Trialist Dr. Christabel Nyange, and then by expert faculty ... Show More
5m 43s
Oct 2024
35. Pulmonary Embolism Masterclass with Dr. Rich Channick
On this week's release, Cyrus and Nick revisit one of their favorite topics: Pulmonary Embolism! In this episode - a follow up to our two-parter from season 1 - we sit down with Dr. Rick Channick of UCLA to talk about his approach to PE management with a focus on catheter directe ... Show More
1h 8m
Jul 10
Clinical Challenges in Vascular Surgery: The Risk & Reality of EVAR Complications
It’s 2 a.m. The on-call resident’s voice is shaky. The CT shows an 18cm abdominal aortic aneurysm with a Type 1B endoleak. There’s gas in the sac, fluid in the belly, and the patient has a defibrillator on both sides of his chest. Is it a rupture? A graft infection? An aortoenter ... Show More
26m 55s
Nov 2024
399. Guidelines: 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure – Question #37 with Dr. Clyde Yancy
The following question refers to Section 7.4 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. The question is asked by the Director of the CardioNerds Internship Dr. Akiva Rosenzveig, answered first by Vanderbilt AHFT cardiology fellow Dr. Jenna Skowronski, ... Show More
8m 40s
Sep 2024
391. Guidelines: 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure – Question #35 with Dr. Mark Drazner
The following question refers to Section 2.2 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. The question is asked by University of Colorado internal medicine resident Dr. Hirsh Elhence, answered first by University of Chicago advanced heart failure cardio ... Show More
6m 3s
Sep 29
Clinical Challenges in Trauma Surgery: Stabbed in the Back - Decision Making in a Penetrating Junctional Vascular Injury
“It’s 5pm and your Consultant (attending) has headed off home. A patient arrives in the resuscitation room blood spurting from a stab wound in the armpit. Join Roisin – a junior Major Trauma fellow, Prash – a surgical trainee, Max – a senior trauma surgery fellow, and Chris – a C ... Show More
33m 53s
Sep 8
426. Case Report: A Ruptured Saccular Aortic Aneurysm into the Right Ventricle – University of Tennessee, Nashville ​
CardioNerds join Dr. Neel Patel, Dr. Victoria Odeleye, and Dr. Jay Ramsay from the University of Tennessee, Nashville, for a deep dive into cardiovascular medicine in the vibrant city of Nashville. They discuss the following case: A 57-year-old male with a history of prior cardia ... Show More
36m 9s
Aug 2024
386. Beyond the Boards: Cardiomyopathies with Dr. Steve Ommen
CardioNerds (Drs. Teodora Donisan, Jenna Skowronski, and Johnny Hourmozdi) discuss Cardiomyopathies with Dr. Steve Ommen. Through a case-based discussion, we review the diagnostic evaluation of suspected restrictive cardiomyopathy, and Dr. Ommen shares his expertise in the nuance ... Show More
37m 30s