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CPR in Aortic Stenosis — FRCA Final MCQ

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HardAnaesthetic Equipment & SafetyCPR in Aortic StenosisFRCA Final

A 75-year-old man (ASA IV) with severe aortic stenosis (AVA 0.6 cm², mean gradient 55 mmHg) undergoes emergency surgery. He arrests intraoperatively with PEA. What specific factor makes CPR less effective in severe aortic stenosis?

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Correct answer: D — The stenotic valve prevents effective forward flow during chest compressions

In severe aortic stenosis, the stenotic valve acts as a fixed obstruction to left ventricular outflow. During CPR, chest compressions generate a cardiac output of approximately 25-30% of normal. With a critically stenotic valve, even this reduced output cannot pass effectively through the valve, making chest compressions less effective at generating forward flow. Additionally, the hypertrophied LV is more susceptible to ischaemia during the reduced coronary perfusion of cardiac arrest. These patients have extremely poor survival from cardiac arrest. Consideration of emergency sternotomy and direct cardiac compression may be appropriate in the operating theatre.

Reference: Resuscitation Council UK – 2021 – Special circumstances: cardiac arrest; ESC – 2021 – Valvular disease