5. Definition of Cardiac arrest:
Sudden cessation of heartbeat and cardiac function, resulting in the loss
of effective circulation.
or
Absence of systole; failure of the ventricles of the heart to contract (usually
caused by ventricular fibrillation) with consequent absence of the heart
beat leading to oxygen lack and eventually to death
6. Diagnosis of cardiac arrest (TRIAD):
Loss of consciousness, unresponsiveness
Loss of normal breathing Apnea.
Loss of pulse and blood pressure {apical & central pulsations
(carotid, femoral loss}
8. Symptoms of cardiac arrest
Symptoms
cardiac arrest symptoms are immediate and drastic.
Sudden collapse
No pulse
No breathing (respiration arrest – may be in 30 seconds after cardiac arrest
Loss of consciousness
enlargement of pupils – may be in 90 seconds after cardiac arrest
10. Our Ultimate Goal
To find the best treatment methods
for managing cardiac arrest, in order
to save more lives!
11. Delay Can Be Deadly
Patient delay is the biggest cause of not
getting care fast.
Do not wait more than a few minutes—
5 at the most
12. “Chain of Survival”
Early Access to Care – Know the Signs
Early CPR, Cardiopulmonary Resuscitation
especially with quality chest compressions
Rapid defibrillation(with AEDs) (an electrical
shock to the heart)
Effective paramedics (advanced life support )
Follow up care (post-cardiac arrest care)
17. ABCDE approach
Breathing
Treatment of breathing problems
Airway
Oxygen
Treat underlying cause
- e.g. drain pneumothorax
- e.g . Nebulizers
Support breathing if inadequate
- e.g. ventilate with bag valve mask
B
18. ABCDE approach
Circulation
Look at the patient
Pulse –
central pulse (carotid)
peripheral pulse
Peripheral perfusion
capillary refill time
( normally <2 sec)
Blood pressure
Monitor
C
23. Defibrillation
All moving away from stacked shocks to single shocks
Reduces pauses in chest compressions
Still role for initial stacked shocks if cardiac arrest occurs in
presence of defibrillator
All recommend immediate CPR after defibrillation (without
rhythm or pulse check)
Different recommendations on joules (150-360J)
Between guidelines
Between manufacturers
Between monophasic and biphasic
There may be a role for CPR before defibrillation in some
Particularly if in VF for more than a few minutes
Right heart dilation an impediment to defibrillation
Confused?
24. Defibrillation
We (St John CMG) recommend a simple
approach
Start with one round of stacked shocks if cardiac
arrest occurs in presence of defibrillator, then go to
single shocks
Always use maximum joules
Opt for defibrillation first
Round kids off to nearest 10kg and use 5J/kg
26. Starting and stopping
These decisions can be difficult
A resuscitation attempt should
begin in most patients
Except where the patient is
clearly dead (livedo, rigor
mortis)
Or where they are clearly
dying and it would be
inappropriate
A competent patient can
decline therapy but neither a
patient nor their family can
demand therapy that is
medically inappropriate
Some scenarios have >99%
mortality rates
Unwitnessed cardiac arrest
with initial rhythm of asystole
27. Starting and stopping
The chances of survival fall
rapidly with time
Exponential falling curve
There is no absolute cut off
when mortality becomes
zero
Resuscitation attempts
requiring longer than 20
minutes of CPR have a very
high mortality rate
We recommend stopping at
around 20 minutes unless
there is a clinical reason to
continue for longer
Transport to hospital with
CPR enroute usually has no
role
30. Ventricular Fibrillation (VF)
What VF looks like on an EKG
Shock “converts” VF to better rhythm
Defibrillation (electrical shock) is
the primary solution (cannot be
used in other lethal heart rhythms)
34. Epinephrine (Adrenaline)
First line cardiac arrest drug, given after every 3
minutes of CPR
Dose 1mg (10ml of 1 in 10,000) IV
Causes vasoconstriction, increased systemic vascular
resistance increasing cerebral and coronary perfusion
Increases myocardial excitability, when the myocardium
is hypoxic or ischaemic
35. Atropine
Given for asystole or pulseless electrical activity with a
rate less than 60 beats per minute
3mg is given as a single intravenous dose
It blocks the activity of the vagus nerve on the SA and
AV nodes, increasing sinus automaticity and facilitating
AV node conduction
36. Amiodarone
For Refractory VF/VT; haemodynamically
stable VT and other resistant
tachyarrhythmias
If VF or pulseless VT persists after the first 3
shocks then Amiodarone 300mg is considered.
If not pre-diluted, must be diluted in 5%
dextrose to 20ml. (Will crystallise is mixed
with saline)
Should be given centrally but in an emergency
can be given peripherally
Increases the duration of the action potential
in the atrial and ventricular myocardium
37. Magnesium Sulphate
For refractory VF when hypomagnesaemia is possible;
ventricular tachyarrhythmias when hypomagnesaemia is
possible
In refractory VF – 1 to 2g (2-4ml of 50% magnesium
sulphate) peripherally over 1 to 2 minutes.
Other circumstances 2.5g (5ml of 50% magnesium
sulphate) over 30 minutes
38. Lidocaine (Lignocaine)
For Refractory VF/ pulseless VT (when Amiodarone is
unavailable
100mg for VF/ pulseless VT that persists after three
shocks. Another 50mg can be given if necessary
39. Sodium Bicarbonate
Given for severe metabolic acidosis and Hyperkalaemia
50mmol (50ml of 8.4% solution), where there is an
acidosis or cardiac arrest associated with Hyperkalaemia
40. Calcium
Administered when pulseless electrical activity caused
by:
Hyperkalaemia
Hypocalcaemia
Overdose of Calcium channel blocking
drugs
Dose 10ml of 10% calcium chloride repeated according
to blood results
41. Controllable Risk Factors
Smoking
Diabetes
High blood cholesterol
High blood pressure – especially stroke
Overweight/obesity
Physical inactivity
42. Lifestyle Changes
Reduce intake of fatty foods and eat more fruits and
vegetables
Walk 30 minutes a day
Exercise prevents stroke, heart disease and other conditions
