1.

HYPOVOLEMIA/HEMORRHAGIC :

Hypovolemia from blood loss is a leading cause of death in traumatic cardiac arrest. External blood loss
is usually obvious. Treatment of hypovolemia includes rapid infusion of preferably warmed crystalloids
and/or blood products while treating the original cause of the hypovolemia.

2. HYPOXIA:

Treating the cause of hypoxia (like: obstruction: soft tissues (coma), laryngospasm, aspiration, Anaemia,
Asthma, Avalanche burial, Central hypoventilation) must be done quickly because this is one of the
potentially reversible causes of cardiac arrest. Proper oxygenation and ventilation are key to restoring
adequate amounts of oxygen into the system and negating the lethal cardiac rhythm.

3. HYPOTHERMIA

The risk of hypothermia is increased by alcohol or drug ingestion, exhaustion, illness, injury or neglect
especially when there is a decrease in the level of consciousness. As core temperature decreases, sinus
bradycardia tends to give way to atrial fibrillation followed by VF and finally asystole. Arrhythmias other
than VF tend to revert spontaneously as core temperature increases, and usually do not require
immediate treatment. Unless the patient goes into VF, rewarm using active external methods (e.g.,
forced warm air) and minimally invasive methods (e.g., warm IV infusions).

4. HYPOKALEMIA/HYPERKALEMIA

Electrolyte abnormalities can cause cardiac arrhythmias or cardiac arrest, and life-threatening
arrhythmias are associated most commonly with potassium disorders, particularly hyperkalaemia. The
precise values that trigger treatment decisions will depend on the patient’s clinical condition and rate of
change of electrolyte values.

a. Hyperkalaemia

Hyperkalaemia is the most common electrolyte disorder associated with cardiac arrest. There is no
steadfast numeric limit universally used to define hyperkalaemia, but 5.5 mmol-1 is commonly
recognized. The treatment for hyperkalaemia involves five key strategies:

- Cardiac protection
- Shifting potassium into cells
- Removing potassium from the body
- Monitoring serum potassium and blood glucose
- Prevention of recurrence
b. Hypokalaemia

Hypokalaemia is the most common electrolyte disturbance in clinical practice. Hypokalaemia is defined
as a serum potassium level <3.5 mmol-1 and severe hypokalaemia is a serum potassium <2.5 mmol-1.
Treatment of hypokalaemia depends on the severity and the presence of symptoms and ECG
abnormalities. The best course of action is the gradual replacement of potassium to normal serum
levels. In an emergency, intravenous potassium is warranted, with the knowledge that many patients
who are hypokalaemia are also hypomagnesimic. Repletion of magnesium stores will facilitate more
rapid correction of hypokalaemia and is recommended in severe cases of hypokalaemia.
 5. CORONARY THROMBOSIS

Coronary heart disease is the most frequent cause of out-of-hospital cardiac arrest. Although proper
diagnosis of the cause may be difficult in a patient already in cardiac arrest, if the initial rhythm is VF it is
most likely that the cause is coronary artery disease with an occluded large coronary vessel.

Treatment options include immediate coronary angiography, primary percutaneous coronary

intervention (PPCI) or other interventions such as (more rarely) pulmonary embolectomy. Ongoing CPR
and immediate access to the catheterization laboratory may be considered if a prehospital and in-
hospital infrastructure is available with teams experienced in mechanical or hemodynamic support and
rescue PPCI with ongoing CPR.

6. PULMONARY EMBOLISM

Cardiac arrest from acute pulmonary embolism is the most serious clinical presentation of venous
thromboembolism, in most cases originating from a deep venous thrombosis (DVT). The 2014 European
Society of Cardiology Guidelines on the diagnosis and management of acute pulmonary embolism define
“confirmed pulmonary embolism” as a probability of pulmonary embolism high enough to indicate the
need for specific treatments.

However, pulmonary embolism may not be symptomatic until it presents as sudden cardiac arrest.
Specific treatments for cardiac arrest resulting from pulmonary embolism include administration of
fibrinolytics, surgical embolectomy and percutaneous mechanical thrombectomy.

7. TOXICITY

Airway obstruction and respiratory arrest secondary to a decreased conscious level is a common cause
of death after self-poisoning (benzodiazepines, alcohol, opiates, tricyclics, barbiturates). Early tracheal
intubation of unconscious patients by trained personnel may decrease the risk of aspiration. Drug-
induced hypotension usually responds to IV fluids, but occasionally vasopressor support (e.g.,
noradrenaline infusion) is required.

8. TAMPONADE

Cardiac tamponade occurs when the pericardial sac is filled with fluid under pressure, which leads to
compromise of cardiac function and ultimately cardiac arrest. Thoracotomy or pericardiocentesis is used
to treat cardiac arrest associated with suspected traumatic or non-traumatic cardiac tamponade. The
use of ultrasound guidance during pericardiocentesis is preferred, if available.

9. PNEUMOTHORAX

It is a treatable cause of cardiac arrest and should be excluded during CPR. A pneumothorax develops
when there is a build-up of air in the pleural space. Pneumothorax can occur in a variety of clinical
situations including trauma, asthma, and other respiratory diseases, but can also be iatrogenic following
invasive procedures (e.g., attempts at central venous catheter insertion). Treatment of a pneumothorax
is either needle compression and/or thoracotomy with chest tube placement.