Cardiac Arrest (including post-arrest care)

Overview

Cardiac arrest is a state of circulatory failure due to a loss of cardiac systolic function. It is the result of 4 specific cardiac rhythm disturbances:

• Ventricular fibrillation
• Pulseless ventricular tachycardia
• Pulseless Electrical activity
• Asystole

Epidemiology

• Survival is estimated at <20% for patients presenting out-of-hospital with VF, and <10% overall for patients presenting with out-of-hospital cardiac arrest.
• 36% of patients with VF/ VT & 11% of patients with PEA/asystole, presenting in-hospital, survive to discharge.

Initial Assessment and Management

PRIMARY SURVEY
	Assessment	Management
Airway	Patency
	Look – swelling, injury or object around mouth/face	Jaw thrust, chin lift, positioning, clear debrisGuedel, nasopharyngeal airway, LMA
	Listen – speech, stridor, gurgling
	Feel – facial fractures
	Protection
	AVPU or GCS	Intubate GCS <8 → cricothyroidectomy if unsuccessful
Breathing	Look, listen, feel
	Effort – Respiratory rate, accessory muscle use, chest wall movement	High flow 100% oxygen. Commence CPR if unresponsive or not breathing
	Efficiency – SaO2, cyanosis, paradoxical breathing	+/- ABG
	Injury – tracheal position, flail chest, chest injury	Treat pneumothorax of injury. Chest X-ray
Circulation	HR, BP, capillary refill	IV access 2 large bore cannula – Fluid resus
	Heart sounds
	ECG	Arrhythmia – Defib
Disability	GCS/AVPU	Maintain cerebral perfusion – O2, ventilation and circulation (above)
	Blood sugar level	Hypoglycaemia- IV dextrose OR Hyperglycaemia – Insulin
	Pupils – reactive and equal
	Neurological assessment
Exposure	Temperature	Maintain normothermia – blankets, +/-heaters
	Assess other part of body including back	Manage injuries

Advanced Life Support

Shockable Rhythms

• Pulseless Ventricular tachycardia
• Ventricular Fibrillation

Non-Shock

• PEA
• Asystole

---

Defibrillation is a process used to stop irregular crazy heartbeats by sending an electric shock in an attempt to revert the heart back to normal rhythm.

Process for using a defibrillator- COACHED

• Compression continued
• Oxygen away
• All else clear
• Charging
• Hands off/Im safe
• Evaluate rhythm
• Defibrillation or disarm and dump

Reversible causes of Cardiac Arrest

Causes 4 H’s & 4 T’s

• Hypoxia
• Hypovolaemia
• Hyper/Hypokalaemia
• Hyper/Hypothermia
• Tension pneumothorax
• Tamponade
• Toxins
• Thrombosis (pulmonary or coronary)

REVERSIBLE CAUSES OF CARDIAC ARREST
Cause	Assessment	Management
Hypoxia	SpO2 %, ABG/VBG	Airway, Breathing; Ventilatimg with high flow O2
Hypovolaemia	BP, HR, identify site of fluid loss, Burns etc	IV fluids 20 ml/kg
Hypothermia	Shivering, core temperature	Warm the patient aggressively to achieve a core temperature > 30°C
Hyperkalaemia	EUC, ABG, ECG changes – peak T-waves, widened QRS	Insulin + glucose +/- calcium gluconate
Hypokalaemia	EUC, ABG,  ECG changes – flat or inverted T-waves	Potassium infusion
Tamponade (cardiac)	Becks triad jugular vein distension, hypotension, muffled heart sounds	Pericardiocentesis
Tension pneumothorax	Unilateral chest expansion, trachea deviated away from pneumothorax, ↓breath sounds (air entry), hyper- resonant percussion note	Needle decompression with large bore cannula (2nd intercostal space, mid clavicular line)
Toxins	Angioedema, History!, abnormal  LFTs, signs of toxicity	Antidote if exists. Supportive therapy
Thrombosis	Hypotensive, SOB, chest pain, collapse, recent surgical procedure (DVT risk factors)	Fibrinolytics are recommended in cases where PE is known or suspected