Reanimación cardiopulmonar con protocolo CSU-ALS
Resumen
ANTECEDENTES: La incidencia del paro cardiaco posquirúrgico, en pacientes operados del corazón, es de 0.7-8%. El pronóstico de soporte vital avanzado es relativamente bueno en unidades quirúrgicas cardiovasculares, que a partir de 2009 recomienda la European Association for Cardio Thoracic Surgery y la Society of Thoracic Surgeons en 2017.
CASO CLÍNICO: Paciente con diagnóstico de coartación aórtica yuxtaductal, con hipoplasia de arco aórtico, que ingresó a cuidados intensivos pediátricos después de la corrección quirúrgica con interposición de un injerto protésico de Woven Dacrón® en el sitio afectado que, a las 72 horas, tuvo un paro cardiaco; se inició el protocolo de soporte vital avanzado en unidades quirúrgicas cardiovasculares que, a diferencia del protocolo universal de soporte vital pediátrico avanzado que recomienda la American Heart Association se interrumpen todas las infusiones, incluidos los inotrópicos, no se administran dosis de adrenalina y se interrumpen las compresiones torácicas para permitir la reesternotomía, con ello se evita perder tiempo en compresiones ineficaces.
CONCLUSIONES: El protocolo CSU-ALS aporta orientación dirigida, específicamente a pacientes con paro cardiaco posquirúrgico, a diferencia del protocolo PALS, que recomienda la American Heart Association de forma estandarizada para todos los pacientes, sobre todo, ante un paro cardiaco no advertido y sin monitorización.
Citas
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