Background

Cardiac arrest induction is the intentional triggering of a cardiac arrest, particularly in hospitals or when conducting research. It is done for research purposes of observing or assessing the heart’s function, carrying out the test on the operation of Cardiopulmonary resuscitation (CPR) techniques, and assessing and testing cardiac medical products, including defibrillators, among others. This is done to mimic sudden cardiac arrest which is aimed at enabling different interventions and observations to be made for a while with the help of temporary stopping of normal heart rhythm. 

Cardiac arrest induction 

Indications

• Cardiac Surgery: Sometimes, during operations on the heart, like heart transplantation or surgeries connected with the correction of congenital heart disease, cardiopulmonary arrest may be used to achieve a bloodless field and to decrease the chances of heart muscle damage. 
• Therapeutic Hypothermia: In some of the cases of severe hypothermia, the intentional initiation of cardiac arrest is known to be used during the process of rewarming, though relatively rare. 
• Cardiopulmonary Bypass: For surgeons to perform cardiopulmonary bypass surgery on a heart, cardiac arrest must be induced. 
• Ablation Procedures: In some circumstances, the induction of cardiac arrest can aid in the ablation therapy of specific arrhythmias. 
• Organ Donation: Under regulated circumstances, it is possible to cause cardiac arrest in people who have been deemed brain dead to ease the extraction of their organs. 

Contraindications

• Uncontrolled Hypertension: In this case, patients with poorly controlled hypertension may have severe cardiac events during and following induced cardiac arrest. 
• Severe Electrolyte Imbalances: The potassium levels, as well as the calcium or magnesium levels, if kept at the wrong level, may cause difficulties in heart hence should be regulated before induction. 
• Active Infection or Sepsis: The following factors are known to predispose a patient to these complications and should be managed before an arrest occurs. 
• Advanced Age or Frailty: Patients who are more likely to suffer from poor outcomes and complications from induced cardiac arrest are the elderly or patients with poor medical status. 

Outcomes

Equipment

Defibrillators 

Pacemakers 

Cardiac Ablation Devices 

Electrical Stimulators 

Pharmacological Agents 

Drugs like epinephrine, amiodarone, and lidocaine  

Monitors and ECG Machines 

External Pacemakers 

Patient Preparation

Pre-Procedure Preparation: 

• Informed Consent: Ascertain that the patient’s family understands the procedure to be undertaken, the risks involved, and the benefits to be expected.
  Obtain written informed consent. 
• Medical Evaluation: Perform history taking including taking the detailed medical history and physical assessment on the patient.
  Complete investigative investigations (for example, ECG, echocardiogram examination, and blood analysis). 
• Pre-Medication: Give prescribed medicine like sedatives and anxiolytics.
  Since the patient will require general anesthesia, the patient should be NPO (Nothing by mouth) hours before the operation. 

Organization of the Procedure Room 

• Equipment Preparation: Make sure that you have all the necessary equipment with you, and that they are in appropriate condition (defibrillator, monitoring devices, IV lines, ventilators, etc.) 
• Sterile Environment: Cleanse the environment to avoid contraction of diseases.
  Patient Monitoring and Anesthesia 
• Vital Signs Monitoring: Continually assess the patient’s physical status (pulse, blood pressure, oxygen level). 
• Anesthesia Induction: Sedate the patient using general anesthesia so that they do not feel any pain and are unconscious all through the surgery.
  Secure the airway with an endotracheal tube and connect to a mechanical ventilator. 

Post-Procedure Care: 

• Restoration of Heart Function: Gradually rewarm the patient if hypothermia is induced.
  Stabilize the patient and give medicine; use a defibrillator when required to help pump the heart. 
• Post-Arrest Monitoring: Supervise the patient for the development of discomforts like arrhythmias or fluctuation in their hemodynamic status.
  Assist in the post-operative care delivered in an Intensive Care Unit if necessary. 
• Recovery and Follow-Up: Ensure the patient receives all necessary medical and nursing interventions for physical rehabilitation.
  Make a schedule for the subsequent appointments to evaluate the treatment results and assess the outcome in case of possible adverse effects. 

Technique

Purpose and Applications 

• Medical Training: To educate the personnel of healthcare facilities about different aspects of Cardiac Arrest. 
• Research: Ideally, to investigate how various mediations impact cardiac arrest and resuscitation. 
• Device Testing: To check what is done and how the usage of defibrillators, AEDs, and other necessary emergency equipment. 

Methods of induction 

Drug-Induced Cardiac Arrest 

• Anesthetic Agents: Propofol or barbiturates can be used to make the patient unconscious and then stop the heart while in the operating room. 
• Electrolyte Imbalance: Large intravenous doses of potassium Chloride can interfere with the normal depolarization of the heart, resulting in the arrest. 
• Antiarrhythmic Drugs: High doses of drugs like lidocaine or procainamide can sometimes induce cardiac arrest by altering the heart’s electrical conduction system. 

Electrical Induction 

• Defibrillation: A defibrillator is a device used to recommend the electric shock to the heart that causes the abnormal heart rhythm called ventricular fibrillation and leads to cardiac arrest. 
• Pacemaker or ICD Manipulation: Tachyarrhythmias can be either provoked by the pacing wires or permanent ICD implants depending on the required arrhythmogenic substrate. 

Surgical Techniques 

• Aortic Cross-Clamping: In some forms of cardiac surgery for example, it is possible to clamp the aorta to stop circulation to the heart and thus cause cardiac arrest. 
• Hypothermia: Cooling the body or heart to even extremely low temperatures may also cause slowed metabolism and the technique is used to cause the heart to stop beating in a few surgeries. 
• Monitoring and Safety Monitoring: A continuous monitoring of the patient’s vital signs, ECG and other parameters is required so that the procedure is kept within safe parameters and so that resuscitation efforts can be directed from the monitors. 
• Safety Measures: This is because it is a potentially life-threatening procedure and should only be done under controlled conditions with adequate resuscitation equipment and skilled manpower. 

Laboratory tests

• Electrocardiogram (ECG): To record the electrical activity of the heart and to determine the presence of any abnormalities in pulse rate. 
• Blood Gas Analysis: To measure the amount of oxygen and carbon dioxide in the blood and thus evaluate the state of metabolism and respiratory status. 
• Serum Electrolytes: Measuring the concentration of electrolytes such as potassium, sodium, and calcium that are vital in proper contraction of the heart muscles. 
• Cardiac Enzymes: Thus, one can compare the levels of troponins along with other indicators to assess the degree of cardiac injury. 
• Hemoglobin and Hematocrit: The following was used to evaluate the entire blood oxygen-carrying capacity as well as the volume. 

Complications

• Hypoxia: Lack of oxygen for long can lead to severe cases of brain damage and, in extreme cases, death. Also, minor hypoxic events, such as those lasting a few hours, can provoke long-term consequences. 
• Acidosis: Prolonged ischemia can result in the accumulation of acids in the blood; this significantly increases the risk and the severity of a cardiac arrest, as well as affects the work of the body’s organs. 
• Arrhythmias: It was also established that inducing cardiac arrest may have complications such as Arrhythmias, which complicates by possibly worsening the situation. 
• Organ Damage: Prolonged cardiac arrest can cause damage to organs, particularly the heart, brain, kidneys, and liver. This damage can be acute or chronic. 
• Reperfusion Injury: Depending on the causes of tissue hypoxia, reperfusion, which results after the restoration of the blood flow after a cardiac arrest, can cause inflammation and oxidative stress, which result in other tissue damages. 

References

Arrest on Induction | SpringerLink 

Cardiac Arrest Upon Induction of General Anesthesia – PMC (nih.gov) 

References

Arrest on Induction | SpringerLink 

Cardiac Arrest Upon Induction of General Anesthesia – PMC (nih.gov)