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OVERVIEW AND DEFINITIONS

Cardiovascular collapse is severe hypotension from acute dysfunction of the heart or peripheral vasculature causing hypotension with resulting cerebral hypoperfusion and loss of consciousness that can be the result of a cardiac arrhythmia, severe myocardial or valvular dysfunction, loss of vascular tone, and/or acute disruption of venous return (see Table 299-1). When an effective circulation is restored spontaneously, patients present with syncope (see Chap. 18). If spontaneous resolution does not occur, then cardiac arrest occurs, ultimately resulting in death if resuscitation attempts are unsuccessful or not initiated. Underlying etiologies for cardiovascular collapse include benign conditions such as vasovagal syncope, but also life-threatening conditions, including: ventricular tachyarrhythmias, severe bradycardia, severely depressed myocardial contractility, as with massive acute myocardial infarction (MI) or pulmonary embolus, and other catastrophic events interfering with cardiac function such as myocardial rupture with cardiac tamponade or papillary muscle rupture with torrential mitral regurgitation.

Table 299-1Distinction between Cardiovascular Collapse, Cardiac Arrest, and Death

Sudden cardiac arrest (SCA) refers to an abrupt loss of cardiac function resulting in complete cardiovascular collapse due either to an acute life-threatening cardiac arrhythmia or abrupt loss of myocardial pump function that requires emergency medical intervention for restoration of effective circulation. Most SCAs occur outside the hospital, and fewer than 10% of these victims survive to be discharged from the hospital despite undergoing attempted resuscitation by emergency medical services (EMS). For those that die prior to hospital admission, a cardiovascular cause ...

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