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Source: Barletta JR, Wilt JR. Cardiac Arrest. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. Accessed June 25, 2012

  • Cardiopulmonary arrest
  • Circulatory arrest

  • Cessation of cardiac mechanical activity as confirmed by absence of signs of circulation (e.g., undetectable pulse, unresponsiveness, apnea).

  • Coronary artery disease
  • Cardiomyopathies (e.g., hypertrophic or dilated cardiomyopathy)
  • Structurally abnormal congenital cardiac conditions
  • Structurally normal but electrically abnormal heart conditions
  • In pediatric patients, cardiac arrest may follow respiratory failure or progressive shock.
  • Out-of-hospital arrests often associated with trauma, sudden infant death syndrome, drowning, poisoning, choking, severe asthma, and pneumonia.
  • In-hospital arrests associated with sepsis, respiratory failure, drug toxicity, metabolic disorders, and arrhythmias.

  • Primary cardiac arrest: Arterial blood fully oxygenated at time of arrest.
  • Secondary cardiac arrest: Results from respiratory failure, leading to hypoxemia, hypotension, and cardiac arrest.
  • Usually results from arrhythmias in adults (e.g., ventricular fibrillation [VF], pulseless ventricular tachycardia [PVT]).
  • Most pediatric arrests related to respiratory rather than cardiac causes.

  • Sudden cardiac death accounts for ~15% of all death in Western countries (330,000 per year in United States).
  • Lifetime risk 3 times greater in men than women.

  • Because primary cause is coronary artery disease, preventive measures include healthy diet, appropriate exercise, smoking cessation, blood pressure control, and management of dyslipidemia.

  • Family history of coronary artery disease
  • Personal history of myocardial infarction (MI) or previous cardiac arrest
  • Smoking
  • Hypertension
  • Dyslipidemia
  • Obesity
  • Diabetes
  • Sedentary lifestyle
  • Increasing age
  • Male sex
  • Use of certain illegal drugs (cocaine, amphetamines)

Signs and Symptoms

  • Onset may be associated with:
    • Anxiety, mental status changes, or unconsciousness
    • Cold, clammy extremities
    • Dyspnea, shortness of breath, or no respiration
    • Chest pain
    • Diaphoresis
    • Nausea or vomiting
  • Physical signs may include
    • Hypotension
    • Tachycardia
    • Bradycardia
    • Irregular or no pulse
    • Cyanosis
    • Hypothermia
    • Distant or absent heart and lung sounds

Means of Confirmation and Diagnosis

  • Observation of clinical findings consistent with cardiac arrest
  • Confirmation by evaluating vital signs, especially heart rate and respirations

Diagnostic Procedures

  • Electrocardiography (ECG) to determine cardiac rhythm
    • VF: Electrical anarchy of ventricle resulting in no cardiac output and cardiovascular collapse.
    • Pulseless electrical activity (PEA): Absence of detectable pulse and presence of electrical activity other than VF or PVT.
    • Asystole: Flat line on ECG monitor.

Differential Diagnosis

  • Return of spontaneous circulation (ROSC) with effective ventilation and perfusion.
  • After successful resuscitation, optimize tissue oxygenation, identify precipitating causes, and prevent subsequent episodes.

  • Implement each of 5 elements in “chain of survival” promptly:
    • Immediate recognition of cardiac arrest and activation of the emergency response system
    • Early CPR ...

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