Cardiac Arrest

CARDIAC ARREST

DR. ABU TAREK IQBAL
MBBS, D-CARD, MD (MEDICINE), MD (CARDIOLOGY)
ASSISTANT PROFESSOR & CONSULTANT CARDIOLOGIST
NATIONAL HEART FOUNDATION HOSPITAL & RESEARCH
INSTITUTE

 Cardiac arrest is characterized by abrupt Loss of consciousness caused by lack of adequate
cerebral blood flow as a result of failure of cardiac pump function.
 A victim of cardiac arrest is unresponsive, pulse less & apneic
 Cardiac arrest is a medical emergency, if not treated immediately, it causes sudden cardiac death.
 Mechanism
 Ventricular fibrillation
 Pulseless ventricular Tachyc ardia
 Cardiac Asystole
 Pulse less Electrical activity (PEA)
 Causes of Cardiac Arrest:
 Acute Ml
 Anesthesia
 Electrocution
 Drowning
 Drugs:-
 Digitalis, Adrenalin, lsoprenaline, Quinidine
 Electrolyte lmbalance-Hypokalemia, Hypomagnesemia
 Hypothermia
R/ F of Cardiac arrest:
 Age - Cardiac Arrest increases age.
 Male - men are two to three times more
 H/O of CAD
 Smoking
 High BP
 Obesity
 DM
 Dyslipidemia
 Alcohol
 Sedentary Life Style
 Drug -Cocaine or Amphetamine
 Electrolyte Imbalance - K or Mg level
 H/O Previous episode of cardiac arrest
 Heart Conditions that can lead to cardiac arrest:
 CAD
 Cardiomyopathy
 Valvular heart disease
 Congenital heart disease
 Electrical problems in the heart
 Heart rhythm abnormalities include conditions such as Brugada syndrome & Long Q T-
syndrome.

C/F:
 Sudden Collapse
 No Pulse
 No Breathing
 Loss of consciousness
 Pupil dilated.
Treatment: Immediate CPR:

 CPR is performed to restore and maintain breathing and circulation and to provide
oxygen and blood flow to the heart, brain & other vital organ.
Technique:
 CPR technique typically includes external delivery of chest compressions and
ventilations/breaths.
Basic Life Support (BLS):
 BLS is the level of medical care which is used for victims until they can be given
full medical care at a hospital.
 It can be provided by trained medical personnel & by laypersons who have
received BLS training. BLS is generally used in the pre hospital setting, and can
be provided without medical equipment.
CPR comprises 3-steps, performed in order:
A. Airway
B. Breathing
C. compressions
Positioning for CPR:
 Patient supine on a relativity hard surface, which allows effective compression of
the sternum.
 The person giving compression should be positioned high enough above the
patient, so that he or she can use bodyweight to adequately compressed the chest.
 Chest compression:
 Pericardial thump-sharp blow with a closed fist on the patients sternum
 Give 30 chest compressions
 Air Way:
 Perform the head tilt chin Lift maneuver to open the airway
 Ventilation:
 If the patient is not breathing, 2 ventilations are given via the providers mouth
 After 30 chest compression, give 2 breaths (30:2 cycle of CPR)
 Give each breath for approximate I second with enough force to make the patient's chest rise
 After giving the 2 breaths, resume the CPR cycle
Compression depth for adults should be at least 2 inches

Compression rate should be at least 100/min
After 30 compressions, 2 breaths are given however an intubated patient should receive continuous compression
while ventilations are given 8-10 times per minute.

Advanced Life support (ALS):
 ALS is a set of life-saving protocol & that extends basic life support to further support the circulation and provide
an open airway and adequate ventilation (breathing).
Component & ALS:
 Tracheal intubation
 Cardiac monitoring
 Cardiac defibrillation
 Intravenous cannulation
 Transcutanaeous pacing
 Medication administration through parenteral routes.
Medication:
 Having adrenaline is generally recommended every five minute 1mg 1/V
 Lignocaine, Amiodarone
Cardiac rhythms of cardiac arrest can be divided into two groups:
 1. Ventricular fibrillation/pulseless ventricular tachycardia (VF/VT)
 2. Other cardiac rhythms, which include asystole and pulseless electrical activity (PEA).
 The principal difference in treatment of the two groups of arrhythmias is the need for attempted
defibrillation in the VF/VT group of patients.

Asystole:
 Atropine 3 mg IV should be given to block all vagal output.
 In the presence of p waves on the ECG strip/monitor, pacing (external or transvenous) must be
considered.
PEA:
 Identification of the underlying cause and its correction are both vital for successful resuscitation. Resuscitation must be continued while reversible causes are
being sought.
 Defibrillation
 Random delivery of shock during the cardiac cycle.
 Defibrillation interrupting and terminating the abnormal electrical rhythm without damaging, the heart, thus allowing the sinus node to resume normal
pacemaker activity.
Indication
 • Ventricular fibrillation.
 • Pulseless ventricular tachycardia.
Cardioversion
 Delivery of energy synchronized to the large R wave or QRS Complex.
 It uses energy less than that used for defibrillation.
 Avoids delivering shock during repolarization period (T wave on ECG)

Indication
 Atrial fibrillation
 Reentry SVT
 Atrial flutter
 Monomorphic VT
 Polymorphic VT
 Wide complex tachycardia of uncertain type.

Difference between cardioversion & Defibrillation
Cardioversion Defibrillation
Elective planned procedure Emergency life saving procedure
Synchronized shock Un-synchronized shock
Low energy shock High energy shock
There can be some delay No delay immediate
Anticoagulation needed No anticoagulation needed
Less damage to myocardium More damage to myocardium
Used in most of the arrhythmias except VT/VF. Used in VT/VF.

Predictors of mortality after in Hospital CPR
Before arrest:
 Hypotension (SBP< 1OOmm of Hg)
 Pneumonia
 Renal Failure
During Arrest:
 Arrest duration > 15 min
 Intubation
 Hypotension (SBP < 100mm of Hg)
 Pneumonia

After Resuscitation
 Coma
 Need for pressers
 Arrest duration > 15 min
THANKS

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Treatment: Immediate CPR:

Compression depth for adults should be at least 2 inches

Elective planned procedure Emergency life saving procedure

Synchronized shock Un-synchronized shock

Low energy shock High energy shock

There can be some delay No delay immediate

Anticoagulation needed No anticoagulation needed

Less damage to myocardium More damage to myocardium

Used in most of the arrhythmias except VT/VF. Used in VT/VF.

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