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. http://accesspharmacy.com/content.aspx?aid=7969590.
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,
- 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,
- 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
- 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
- Sedentary lifestyle
- Increasing age
- Male sex
- Use of certain illegal drugs (cocaine, amphetamines)
- Onset may be associated with:
mental status changes, or unconsciousness
- Cold, clammy extremities
- Dyspnea, shortness of breath, or no respiration
- Chest pain
- Nausea or vomiting
- Physical signs may include
- Irregular or no pulse
- Distant or absent heart and lung sounds
Means of Confirmation
- Observation of clinical findings consistent with cardiac
- Confirmation by evaluating vital signs, especially heart rate
- 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.
- 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 ...