Cardiac arrest

Cardiac arrest is a critical emergency characterized by the sudden cessation of effective heart function, leading to the absence of a palpable pulse and loss of consciousness. Immediate and effective interventions are essential for patient survival.

Causes of Cardiac Arrest

• Cardiac causes:
  • Myocardial infarction (MI)
  • Arrhythmias (e.g., ventricular fibrillation, ventricular tachycardia)
  • Cardiomyopathies
• Respiratory causes:
  • Airway obstruction
  • Respiratory failure
• Other causes:
  • Hypovolemia
  • Electrolyte imbalances
  • Drug overdose

Initial Assessment and Management

1. Scene Safety: Ensure safety of rescuers and bystanders.
2. ABCDE Approach:
   • Airway: Assess and establish airway patency. Consider adjuncts (e.g., Oropharyngeal/Nasopharyngeal airway).
   • Breathing: Assess breathing and provide ventilatory support if necessary. Initiate CPR if no breathing detected.
   • Circulation: Assess pulse and initiate chest compressions if absent. Consider defibrillation for shockable rhythms.
   • Disability: Assess level of consciousness using AVPU scale. Evaluate neurological status.
   • Exposure/Environment: Remove clothing barriers for effective assessment and management.

Advanced Life Support (ALS)

1. High-Quality CPR:
   • Compression rate: 100-120/min
   • Compression depth: At least 5 cm (2 inches)
   • Allow full chest recoil between compressions
   • Minimize interruptions in compressions
2. Defibrillation:
   • Follow appropriate protocols for defibrillation in shockable rhythms (e.g., ventricular fibrillation, pulseless ventricular tachycardia).
3. Medications:
   • Epinephrine: Administer every 3-5 minutes during CPR.
   • Amiodarone: Consider in refractory ventricular fibrillation or pulseless ventricular tachycardia.
4. Advanced Airway Management:
   • Consider advanced airway placement (e.g., endotracheal intubation, supraglottic airway) if unable to maintain adequate oxygenation and ventilation with bag-mask ventilation.
5. Post-Resuscitation Care:
   • Optimize hemodynamics and oxygenation.
   • Targeted temperature management in selected patients.

Prognosis and Follow-Up

• Prognosis depends on the underlying cause, duration of arrest, and quality of CPR.
• Post-arrest care should include evaluation and management of potential complications (e.g., hypoxic brain injury, myocardial dysfunction).