The Surgical Technologist (ST) is a specialized member of the operating room (OR) team who works directly with the surgeon, often referred to as the scrub role. An Intraoperative Cardiac Arrest (ICA) is a sudden, unexpected cessation of heart function that occurs while a patient is undergoing a surgical procedure. Unlike cardiac arrests in other hospital settings, an ICA is almost always witnessed and happens in a controlled environment with trained personnel immediately available. The ST’s preparedness and rapid, precise actions are fundamental in maximizing the patient’s chance of survival during this rare, catastrophic event. While the anesthesia team manages the patient’s physiology, the ST’s primary focus shifts to preserving the integrity of the operative field.
Immediate Priorities: Maintaining the Sterile Environment
The ST’s most unique responsibility during an ICA is the immediate protection of the sterile field from contamination. When a cardiac arrest is called, non-sterile personnel and emergency equipment rush into the room, creating an environment of high-risk for breaks in aseptic technique. The ST must remain scrubbed and physically guard the instrument table and the patient’s drape barriers.
The immediate action involves stabilizing all instruments on the sterile back table and the Mayo stand, preventing them from shifting or falling. If the surgeon is operating in a non-thoracic or non-cardiac area, the ST must quickly cover the entire sterile field with a large, sterile drape to protect it from contamination by external rescuers or equipment. This maneuver minimizes the risk of a surgical site infection if the procedure continues.
Maintaining the physical boundaries of the sterile zone is paramount, especially as external cardiac compressions may cause movement of the operating table and drapes. The ST must stand firm, watching for any circulating team member or equipment that inadvertently breaches the sterile barrier. This includes monitoring the hands and gowns of the surgeon and first assistant for contact with non-sterile items rushed into the room.
Instrument and Emergency Equipment Readiness
The ST must immediately anticipate the surgeon’s need to perform an emergency thoracotomy or resternotomy, which may be required to relieve cardiac tamponade or perform open-chest cardiac massage. This requires the rapid assembly and presentation of a highly specialized instrument set not typically used in general surgery. This emergency set often includes a heavy scalpel, a single-piece sternal retractor, and heavy wire cutters to quickly cut any existing sternal wires.
For an open-chest procedure, the ST must also have large, deep retractors and heavy suture materials, like size 0 or 1, ready to control hemorrhage or quickly close the incision if resuscitation is successful. These life-saving tools must be instantly available, often before the surgeon verbally requests them. The ST is also responsible for presenting internal cardiac defibrillator paddles to the surgeon, ensuring the cables are managed so the circulating nurse can safely plug them into the external defibrillator unit.
This process of preparing specialized instruments must occur seamlessly while the ST simultaneously protects the primary sterile field. The efficiency of this preparation can shave off seconds directly related to the patient’s outcome. The Society of Thoracic Surgeons recommends that the time from recognition of arrest to chest re-entry should be less than five minutes, underscoring the urgency of the ST’s role.
Direct Support to the Surgical Team
Once the emergency intervention begins, the ST transitions into a support role, working in lockstep with the surgeon. This hands-on assistance requires superior anticipation of the next step in the emergency sequence. The ST must anticipate the specific needs of the surgeon, providing the correct instrument with a firm, deliberate transfer.
If the chest is opened, the ST must manage suction and irrigation to maintain a clear visual field for the surgeon, which is often obscured by blood or fluid. Large-volume suction is often necessary to immediately clear the pericardial space or chest cavity. The ST may also be directed to hold retraction, using the sternal retractor or large hand-held retractors, to provide the necessary exposure to access the heart or repair a major vessel. The environment demands that the ST maintain calm, non-verbal communication and precision to support the surgeon’s swift, life-saving actions.