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  • 4 rhythms produce pulseless cardiac arrest: ventricular fibrillation (VF), pulseless ventricular tachycardia (VT), pulseless electrical activity (PEA), & asystole
  • Key elements to survival (chain of survival) in patient with cardiac arrest (JAMA 1984;251:1723)
    • Early access; early cardiopulmonary resuscitation (CPR): compressions, airway, breathing (CAB) (Circulation 2010; 122:S250); early defibrillation (10% ↓ in successful intervention for every 1min delay); early advanced cardiac life support (ACLS)
  • Other elements associated with survival
    • Location of cardiac arrest: in-hospital > community (3–4-fold delay in initiation of pharmacotherapy for community cardiac arrest); witnessed > unwitnessed
    • Initial cardiac rhythm
    • Preexisting medical conditions
  • Adult cardiopulmonary arrest usually results from an arrhythmia secondary to thrombosis or pulmonary embolism
  • Goals of ACLS: sustained return of spontaneous circulation (ROSC), limiting end-organ damage, survival to hospital discharge
  • Role of drug therapy: enhance chance of ROSC, facilitate defibrillation
  • Prompt delivery of CPR followed by defibrillation ↑ survival in patients with pulseless VT/VF

Table 5-1 Hemodynamic Parameters
Table 5-2 Evidence-Based Treatment Recommendations (Circulation 2005;112:IV1–203)*

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