Cardiopulmonary arrest is defined as the loss of appropriate cardiac and respiratory function, which leads to death without reversal. This syndrome is frequently encountered in people who have coronary artery disease. This exercise examines the management and prevention of cardiopulmonary arrest, as well as the role of the inter professional team in treating individuals who are experiencing this condition.
- Describe the common symptoms of a patient who has suffered a cardiopulmonary arrest.
- Write a summary of the epidemiology of cardiac arrest in the United States.
- Give a brief overview of the causes of cardiopulmonary arrest.
Introduction to Cardiopulmonary arrest
The absence of efficient breathing and circulation is known as cardiopulmonary arrest (CPA). It’s also referred to as cardiac or circulatory arrest. A initial cardiac event is the most common cause in adults. Ventricular fibrillation is the most prevalent electrical mechanism, accounting for 50 to 80 percent of cardiopulmonary arrests (VF). Pulseless electrical activity (PEA) and asystole are the less prevalent causes of dysrhythmias, accounting for 20% to 30% of all cases. A less common mechanism is pulseless sustained ventricular tachycardia (VT). If not treated quickly, this illness might lead to abrupt death. Cardiopulmonary resuscitation and/or cardioversion or defibrillation, as well as cardiac pacing, can all help to reverse a cardiopulmonary arrest (CPA).
The American Heart Association (AHA) issues updates and recommendations for adult basic life support (BLS) and cardiopulmonary resuscitation (CPR) quality on adults on a regular basis. Regardless of the etiology, early cardiopulmonary resuscitation (CPR) and cardiac monitoring will help establish which pulseless arrest strategy to choose. According to evidence, more than 400000 persons die of cardiac arrest in the United States each year. Cardiopulmonary disease may or may not have been diagnosed.
Causes of Cardiopulmonary arrest
Cardiopulmonary arrest in adults can be caused by a variety of factors that vary by age and demographic. Patients with heart illness, on the other hand, are more likely to have a cardiac arrest. It may also be divided into other categories, including cardiac, respiratory, and traumatic reasons. However, coronary artery disease is thought to be the cause of 75 percent of cardiac arrests.
Coronary Artery Disease
Coronary artery abnormalities:
- Anomalous coronary artery anatomy.
- Acute lesions (platelet aggregation, plaque fissuring, acute thrombosis).
- Chronic atherosclerosis.
- coronary artery spasm
- Hypertrophic cardiomyopathy
Valvular Heart Disease
Infiltrative and Inflammatory Disorders
- Infiltrative diseases
- Noninfectious inflammatory diseases
Dilated CardiomyopathyElectrophysiologic AbnormalitiesInherited Disorders
- Early repolarization syndrome.
- Brugada syndrome
- Short QT syndrome.
- Long QT syndrome.
- Catecholaminergic polymorphic ventricular tachycardia
- Ejection fraction less than 35%
- Tetralogy of Fallot
- Respiratory Causes
- Bronchospasm due to (pulmonary edema, pulmonary hemorrhage, and pneumonia)
- Severe asthma or Chronic Obstructive Pulmonary Disease (COPD).
- Pulmonary Embolism
- Respiratory Muscle Weakness: due to spinal cord injury.
Causes of Trauma
Overall, cardiac causes account for 50 percent to 60 percent of all deaths. The second most prevalent cause, respiratory insufficiency, accounts for 15% to 40% of all cases.
Out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) are two types of cardiac arrest (IHCA). The global incidence of cardiopulmonary arrest, on the other hand, is little documented. In the United States, more than 290,000 instances of IHCA occur in adults each year, whereas 326,000 cases of OHCA occur in adults each year. The majority of these go unnoticed.
Men and women in their forties and fifties have differing susceptibilities to cardiac arrest; but, as they become older, the sex disparities diminish. The difference in risk for cardiopulmonary arrest between males and females is due to differences in age-related risks for various characteristics of coronary heart disease (CHD).
As the gender gap for signs of coronary heart disease closes in the 6th to 8th decades, the excess risk of arrest in males progressively narrows. In spite of the lower incidence among younger women, CHD risk factors such as diabetes (DM), cigarette smoking, hyperlipidemia, and hypertension (HTN) are very highly influential.
The predominance of coronary artery disease as the predominant structural etiologic component correlates with clinical observations on postmortem examinations of cardiopulmonary arrest and sudden cardiac death (SCD) patients. More than 80% of those who died had histological evidence of coronary artery disease. A combination of severe atherosclerosis of the coronary arteries, unstable coronary artery lesions, which include different permutations of fissured, eroded, or burst plaques; and/or thrombosis are common pathologic descriptions. Despite the presence of thrombi and unstable plaques, up to 70% of men who die unexpectedly have previously healed myocardial infarctions, whereas only 20% have recently acute MIs.
Physical and historical context
A cardiac arrest may be preceded by warning signs and symptoms in many people. Nonetheless, these characteristics are frequently overlooked and unrecognized because those who survive cardiopulmonary arrest often suffer from amnesia, whereas those who survive cardiopulmonary arrest and remember the event report palpitations, shortness of breath, nausea, and chest pain as the most common symptoms.
Clinicians examining patients with cardiopulmonary arrest should begin a head-to-toe examination right once, which will aid in the formulation of a care strategy. The physical examination will aid in the diagnosis of cardiopulmonary arrest and offer the most crucial information about the likely etiology and prognosis. While the history will aid in determining when the incident occurred, what the victim was doing, and whether or not drugs were involved. The lack of carotid pulse is often the gold standard for detecting cardiopulmonary arrest. However, several studies have shown that rescuers, whether laypeople or healthcare experts, frequently make mistakes while examining the carotid pulse.
Cardiopulmonary resuscitation should not be stopped while blood or radiological tests are being performed. However, if it does not interfere with cardiac resuscitation attempts, point-of-care tests, such as blood glucose or serum potassium, may be performed. Point-of-care ultrasonography may also be used to assess cardiac activity during cardiopulmonary resuscitation, which has been shown to be useful in several trials.
Management / Treatment
The patient with verified cardiopulmonary arrest is managed in five stages:
- Basic Life Support in addition to the first examination
- Advanced Life Assistance
- Care after resuscitation
- Long-term planning
Basic life support (BLS) and defibrillation can be performed by the general public, physicians, paramedics, trained laypeople, and nurses if a diagnosis of cardiopulmonary arrest has been established. Specialized abilities like as Advanced Life Support (ALS), post-resuscitation care, and long-term treatment of post-cardiopulmonary arrest patients are in more demand. Two major therapies might be used to reverse cardiopulmonary arrest: early CPR and early automated external defibrillation (AED). The detection of cardiopulmonary arrest and BLS procedures is the initial step. If public defibrillation is accessible, it should be enabled and utilized if necessary. Following that, advanced life support (ALS) procedures are implemented.
involving IV/IO medication administration. If spontaneous circulation returns, then the case will undergo post-resuscitation care along with subsequent long-term management. The identification of a cardiopulmonary arrest victim includes ensuring that the patient is unresponsive, pulseless, and having abnormal breathing. Once the patient is identified, immediate CPR and activation of the Emergency Medical Services (EMS) should be done promptly. Nowadays, public access to defibrillation has been adding another layer of response.
BLS and Initial Evaluation
A detailed evaluation of the patient’s state of awareness, skin color, breathing movement, and arterial pulse in the carotid or femoral artery is required to confirm cardiopulmonary arrest. The rescuer’s initial job after verifying the arrest is to contact Emergency Medical Services and begin CPR.
The indications of a foreign body aspiration in the respiratory system, which include acute stridor, dyspnea, and suprasternal and intercostal retractions, must be diagnosed. When we suspect aspiration, we should do the Heimlich technique.
Successful cardiac resuscitation necessitates the maintenance of a patent airway. To keep the airway patent, perform maneuvers like chin raise, head tilt, and jaw push. Any obvious foreign bodies in the oropharynx, such as misplaced dentures, should be removed. If the rescuer is having trouble breathing the patient, ventilation devices such as the oropharyngeal airway (OPA) and the nasopharyngeal airway (NPA) may be employed.
The AHA guideline suggested certain recommendation for doing high-quality CPR:
- Compression should start within 10 seconds of diagnosing cardiopulmonary arrest.
- Two breaths to be given after 30 compressions. Excessive ventilation should be avoided.
- Every effort should be made to reduce the interruption while changing the rescuer or while checking the rhythm.
- The rate of compression should be between 100 to 120 per minute
- The depth of compression should be between 2 to 2.4 inches for adults.
- Adequate time should be given for chest recoil
External Defibrillation (AED) is a type of automated defibrillation that is used to
Nonconventional responders, such as ambulance drivers, police officers, firemen, security guards, and laypeople, can readily use AEDs. Recent research suggests that using an AED by nonconventional responders might increase cardiopulmonary arrest survival rates since the ALS team takes time to arrive, and early defibrillation by nonconventional responders would not only shorten defibrillation time but also enhance patient outcome.
Cardiac Life Support (ACLS) is a type of advanced cardiac life support.
Basic life support, advanced airway help, and medications like epinephrine and amiodarone can all be used in CPR. Supraglottic airway devices and endotracheal tubes are examples of sophisticated airway devices. The ACLS team also has the ability to evaluate cardiac rhythms and use defibrillation as necessary.
ACLS (ADVANCED CARDIAC LIFE SUPPORT) is a type of cardiopulmonary resuscitation that is used to provide enough breathing, regulate blood pressure and cardiac output, control cardiac arrhythmias, and restore organ perfusion. The following are some of the maneuvers required to achieve these objectives:
- Defibrillation and pacing.
- Endotracheal tube intubation and mechanical ventilation
- Intravenous line insertion.
The speed with which defibrillation is conducted is critical for bettering patient outcomes. Certain recommendations for defibrillation were proposed by the AHA guideline.
- While the AED is being charged, cardiopulmonary resuscitation should be performed.
- Intubation and intravenous line placement should be prioritized over immediate early defibrillation.
- A biphasic waveform defibrillator is favored over a monophasic waveform defibrillator.
- For the initial shock, the manufacturer’s suggested energy dosage should be applied. If this isn’t specified, the maximum dosage for defibrillation should be utilized.
- The choice of fixed vs rising energy for consecutive shocks should be based on the advice of the manufacturer. If the machine can increase the energy, a larger level of energy should be employed for the next shock.
- Stacking shock should be avoided in favor of a single shock method.
After a failed defibrillation attempt, 1mg I/V epinephrine should be administered. Furthermore, this medication’s dose can be repeated after three to five minutes. In addition, vasopressin has been suggested as a possible substitute.
Intubation and arterial blood gas analysis should be performed immediately after two or three failed attempts. Patients who are still acidotic following intubation and effective defibrillation should be given 1 new/kg of NaHCO3, with a second dosage of 50% of the first dose given after 10 minutes.
After repeated electrical instability and unsuccessful defibrillation, antiarrhythmic medication with amiodarone may be initiated. 150 mg amiodarone should be administered over 10 minutes, then 1 mg every 6 hours for 6 hours, and 0.5 mg every 18 hours after that. Nowadays, procainamide is seldom used. Calcium gluconate is not thought to be safe, and it should only be used in individuals who have hyperkalemia or have taken a deadly dosage of calcium channel blocker.
Care after resuscitation
The effective restoration of spontaneous circulation kicks off this phase. In general, primary ventricular fibrillation after an acute myocardial infarction (AMI) responds well to treatment and is easily controlled, whereas secondary ventricular fibrillation after an AMI is less responsive to treatment and is more difficult to control, and those patients who are resuscitated successfully have a high rate of VF recurrence. Hemodynamic stability determines the patient’s outcome. In hemodynamically unstable individuals, asystole, bradyarrhythmias, and PEA are prevalent.
The prognosis and clinical picture following in-hospital cardiopulmonary arrest (IHCA) due to noncardiac disorders are poor, and the type of the underlying illness controls the post-resuscitation course in some successfully resuscitated individuals. After IHCA, patients with cancer, central nervous system disorders, and renal failure have a survival rate of fewer than 10%.
After OHCA’s Survival, Long-Term Management
Patients who survive cardiac arrest without brain injury must have a thorough study to determine the cause and have a definitive solution so that future occurrences can be avoided.
Patients who have had cardiopulmonary arrest as a result of myocardial ischemia should be treated with surgical, pharmacological (anti-ischemia treatment), and radiological intervention in order to enhance their long-term survival.
Candidates for implantable cardioverter-defibrillators include survivors of cardiopulmonary arrest caused by conditions such as hypertrophic cardiomyopathies, uncommon hereditary syndromes, right ventricular dysplasia, catecholaminergic polymorphic VT, Brugada syndrome, and long QT syndrome (ICD).
Differential Diagnosis is a term used to describe the process of distinguishing between two
Cardiopulmonary arrest causes patients to lose their pulse and become unconscious. However, several illnesses have clinical symptoms that are comparable to cardiopulmonary arrest. Syncope, seizures, and overdosing on certain medicines, such as opioids, are all examples. Hs and Ts, or reversible causes of cardiopulmonary arrest, should be recognized and treated as soon as possible. It contains the following items:
- Tension pneumothorax
- Toxic overdose of drugs
- Thromboembolism/pulmonary embolism
- Thrombus/acute myocardial infarction
- Cardiac tamponade
Patients who are witness to cardiac arrest and receive timely CPR and defibrillation have a greater chance of survival and recovery. When compared to senior patients with established co-morbidities such IHD, healthy and young people are more likely to regain spontaneous circulation.
During cardiopulmonary resuscitation, a variety of problems might arise. The most prevalent complication is AED failure. Inability to acquire venous access, rib fracture, pneumothorax, pneumomediastinum, hemothorax, lung laceration, pulmonary bleeding, damage to the main artery, and cardiac tamponade are some of the other problems.
Patient Education and Dissuasion
The majority of cardiopulmonary arrests happen outside of hospitals. The two major interventions that have been demonstrated to enhance patient outcomes are immediate cardiopulmonary resuscitation and defibrillation. As a result, even laypeople with proper CPR training and abilities can save lives. However, even the most qualified individual may hesitate to begin CPR due to a lack of trust in their ability to recognize cardiac arrest. This Confirms the need of holding frequent training sessions and workshops to help them improve their abilities and confidence.
Improving the Performance of Healthcare Teams
Cardiopulmonary arrest affects the great majority of individuals who have already been diagnosed with coronary artery disease. Cardiopulmonary arrest can be avoided in such people by slowing the evolution of the condition by modifying modifiable risk factors and taking frequent treatment. Furthermore, healthcare practitioners should inform the patient about the benefits of a good diet, regular exercise, and effective dyslipidemia, hypertension (HTN), diabetes (DM), and smoking cessation treatments. Finally, healthcare workers must be familiar with the fundamental ideas and clinical skills required for efficient cardiopulmonary resuscitation.