Cardiac arrest resident survival guide

For cardiac arrest physician extender algorithm click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Rim Halaby

Synonyms and keywords: cardiorespiratory arrest, cardiopulmonary arrest, circulatory arrest

Definition

A cardiac arrest is the abrupt cessation of normal circulation of the blood due to failure of the heart to contract effectively during systole.

Causes

Cardiac arrest is a life threatening condition which results in immediate death if not treated.

Common Causes

• Arrhythmia
• Cardiomyopathy
• Ischemic heart disease

Reversible Causes

H's

• Hypovolemia
• Hypoxia
• Hydrogen ions (acidosis)
• Hyperkalemia or Hypokalemia
• Hypothermia
• Hypoglycemia or Hyperglycemia

T's

• Tablets or Toxins (tricyclic antidepressants, phenothiazines, beta blockers, calcium channel blockers, cocaine, digoxin, aspirin, acetominophen)
• Cardiac Tamponade
• Tension pneumothorax
• Thrombosis (myocardial infarction)
• Trauma (hypovolemia)

Management

Cardiac Arrest Care

Adult Cardiac Arrest

Start CPR Give oxygen Attach monitor/defibrillator

Rhythm shockable?

Yes

No

VF/VT

Asystole / PEA

Shock

Box A: CPR 2 min IV/IO access

Rhythm shockable?

No

Yes

Shock

Box B: CPR 2 min Epinephrine every 3-5 min Consider advanced airway and capnography

Box C: CPR 2 min IV/IO access Epinephrine every 3-5 min Consider advanced airway and capnography

Rhythm shockable?

No

Rhythm shockable?

Yes

Yes

No

Shock

CPR 2 min Amiodarone Treat reversible causes

Box D: CPR 2 min Treat reversible causes

Go back to box A

No

Rhythm shockable?

Yes

Shock Then, go to box A or box B

If no signs of return of spontaneous circulation: Go to box C or box D If return of spontaneous circulation: Start post cardiac arrest care

Adapted from 2010 AHA guidelines for cardiopulmonary resuscitation and emergency cardiovascular care, part 8.

Acute Immediate Post-Cardiac Arrest Care

Return of spontaneous circulation (ROSC)

Optimize ventilation and oxygenation - Maintain oxygen saturation ≥ 94% - Consider advanced airway and waveform capnography - Do not hyperventilate Start at 10-12 breaths/min Titrate to target PETCO2 of 35-40 mmHg

Treat hypotension (SBP<90 mmHg) - IV/IO bolus 1-2 L normal saline or lactated Ringer's - Vasopressor infusion Epinephrine IV infusion: 0.1-0.5 mcg/kg/min, or Dopamine IV infusion: 5-10 mcg/kg/min, or Norepinephrine IV infusion: 0.1-0.5 mcg/kg/min - Consider treatable causes - 12-Lead ECG

Follow commands?

No

Yes

Consider induced hypothermia

STEMI Or High suspicion of AMI

Yes

No

Coronary reperfusion

Advanced critical care

Adapted from 2010 AHA guidelines for cardiopulmonary resuscitation and emergency cardiovascular care, part 9.