CARDIAC
ARREST
NMORE Pre-
reading
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DEFINITION
Cardiac Arrest is the cessation of
cardiac function resulting in the loss of
blood circulation.
Unexpected cardiac arrest is referred
as Sudden Cardiac Arrest (SCA)
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CAUSES
1. Cardiac causes:
Heart Diseases e.g. Ischemic
heart disease, Congestive Heart
Failure
Arrhythmias e.g. Electrolytic
Disorder
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CAUSES
2. Non-cardiac cause:
Cardiac Tamponade
Pulmonary embolism
Acute Respiratory Failure
Airway Obstruction
Poisoning e.g. Drug Overdose
Hypothermia
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RISK FACTORS
Smoking Sedentary lifestyle
Diabetes Drinking alcohol
High Cholesterol Age
High Blood Gender: Male
Pressure Female
Obesity Family history of
heart disease
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PREVENTIONS
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SYMPTOMS
Loss of consciousness,
responsiveness
No pulse
No breathing
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CLASSIFICATION
Cardiac Arrest can be classified into
Shockable and Non-shockable, as
determined by the ECG rhythm.
1.Shockable rhythms:
• Ventricular Fibrillation (VF)
• Pulseless Ventricular Tachycardia
(VT)
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Ventricular Fibrillation (VF)
Disorganized and irregular rhythm
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Ventricular Tachycardia (VT)
Regular rhythm
Wide QRS complexes
HR: fast ( 100 bpm)
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CLASSIFICATION
2. Non-shockable rhythms:
• Asystole
• Pulseless Electrical Activity (PEA)
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Asystole
Flatline ECG: No P wave & QRS
complexes
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Pulseless Electrical Activity (PEA)
Show electrical activity, but No pulse
detected
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MANAGEMENT OF CARDIAC
ARREST
Chain of Survival
Recognitio Immediate Rapid Advanced
Surveillanc n and high- defibrillati life
e and activation quality on support
prevention of the CPR and
emergency postarrest
response care 14
system
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TIME IS CRITICAL
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OUR ULTIMATE GOAL
To use the best treatment for managing
cardiac arrest in order to save more
lives
For example, Early defibrillation is the
most effective treatment for
terminating VT or Pulseless VT
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Recognize responsiveness
• Shake patient’s shoulder
• Shout “Are you Okay?”
Continue to assess the breathing
and pulse
simultaneously
• Adult – check carotid pulse
• Infant – check branchial pulse
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Confirm no pulse and no breathing
Call for help
• Inform the doctors
• Get emergency cart
• Take defibrillator
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Start cardiopulmonary resuscitation (CPR)
immediately
Maintain CPR sequence C-A-B
C – Circulation: to restore circulation by
chest
compression at:
compression rate: 100-
120/min
compression depth:
at least 2”(5cm), but not
more
than 2.4” (6cm) for adult
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A – Airway: to maintain airway
patent by:
Head tilt chin lift
Jaw thrust for cervical
spine injury patient, or
Tracheal intubation if
possible
or
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B – Breathing: to start artificial
ventilation
10 breaths/min
*A Compression-Ventilation ratio for
adult: 30:2*
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Provide High quality CPR:
• Push hard and fast
• Allowing full chest recoil
between compressions
• Minimizing interruption in chest
compressions (< 10 sec.)
• Avoiding excessive ventilation
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Check rhythm
To identify shockable rhythm or non-
shockable rhythm
VT or Pulseless VT
Early defibrillation
• Monophasic defibrillator
360J
• Biphasic defibrillator
120 – 200J as
manufacturer’s
recommendation
• If not known
considered maximal dose 23
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Asystole or PEA
NO defibrillation
Find underlying cause(s)
• 5 H’s 5 T’s
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UNDERLYING CAUSES
5 H’s 5 T’s
Tension pneumothorax
Hypovolemia
Tamponade, cardiac
Hypoxia
Toxins
Hydrogen ion
Thrombosis, pulmonary
(acidosis) Thrombosis, coronary
Hypo-/
Hyperkalemia
Hypothermia 25
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Provide Advanced Cardiac Life
Support
Drug Therapy
Epinephrine 1:10,000 bolus,
repeated each 3-5 mins
Amiodarone 300mg bolus
Atropine 1.2mg push
Advanced Airway Management
Prepare intubation equipment
Post-resuscitation care 26
management
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Cardiac Arrest Algorithm
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POST RESUSCITATION
MANAGEMENT
Goals:
• Preserve brain injury
• Maintain haemodynamic stability
• Avoid hyperventilation
• Prevent re-arrest
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POST RESUSCITATION
MANAGEMENT
Return of Spontaneous Circulation
(ROSC)
Signs:
• organic rhythm
• palpable pulse
• blood pressure measurable
• breathing
• coughing
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POST RESUSCITATION
MANAGEMENT
Airway & Breathing
Adequate oxygenation and
ventilation
Consider tracheal intubation
Maintain SpO ≥94%
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Avoid hyperventilation
Maintain PetCO2 within normal range
35-40mmHg
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POST RESUSCITATION
MANAGEMENT
Circulation
Consider vasopressor/ inotrope to
maintain SBP > 100 mmHg
Obtain 12-lead ECG
Consider coronary angiography
+/- percutaneous coronary
intervention (PCI)
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POST RESUSCITATION
MANAGEMENT
Body Temperature
Target Temperature Management
(TTM)
• Improve neurologic recovery
• Induce hypothermia for comatose
adult patient
• Maintain body temperature around
32°C to 36°C for 24 hours
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POST RESUSCITATION
MANAGEMENT
Metabolic
Correct electrolytes
Avoid hypokalemia
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ACKNOWLEDGE
1. ACLS Provider Manual and ACLS EP
Manual Comparison Chart. 2015
Interim Training Materials. Based on
2015 AHA Guidelines for CPR and
ECC
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