Cardiac arrest (also known as cardiopulmonary arrest or circulatory

arrest) occurs when the heart ceases to produce an effective pulse and blood
circulation. Maybe caused by a cardiac electrical event, heart rate is too fast
(ventricular tachycardia or ventricular fibrillation) or too slow (bradycardia or AV
block) or no heart rate at all (asystole).Pulseless Electrical Activity (PEA)-
Electrical activity is prevent but theirs is ineffective cardiac contraction or
circulating volume. Can be caused by hypovolemia, cardiac tamponade,
hypothermia, massive pulmonary embolism, medication overdoses, significant
acidosis and massive acute myocardial infarction.

Classification of Cardiac Arrest (based upon ECG rhythm)

1. Shockable- ventricular fibrillation and pulseless ventricular tachycardia

2. Non-shokable- asystole and pulseless electrical activity

Causes

The immediate cause of cardiac arrest is usually an abnormality in your heart

rhythm (arrhythmia), the result of a malfunction in your heart's electrical system.

Unlike other muscles in your body, which rely on nerve connections to receive
the electrical stimulation they need to function, your heart has its own electrical
stimulator — a specialized group of cells called the sinus node, located in the
upper right chamber (right atrium) of your heart. The sinus node generates
electrical impulses that flow in an orderly manner through your heart to
synchronize heart rate and coordinate the pumping of blood from your heart to
the rest of your body.

If something goes wrong with the sinus node or the flow of electric impulses
through your heart, an arrhythmia can result, causing your heart to beat too fast,
too slow or in an irregular fashion. Often, these interruptions in rhythm are
momentary and harmless. But some types of arrhythmia can be serious and lead
to a sudden stop in heart function (sudden cardiac arrest).

The most common cause of cardiac arrest is an arrhythmia called ventricular

fibrillation — when rapid, erratic electrical impulses cause your ventricles to
quiver uselessly instead of pumping blood.

Most of the time, cardiac-arrest-inducing arrhythmias don't occur on their own. In

a person with a normal, healthy heart, a lasting irregular heart rhythm isn't likely
to develop without an outside trigger, such as an electrical shock, the use of
illegal drugs, or trauma to the chest at just the wrong time of the heart's cycle
(commotio cordis).
Risk factors

1. Smoking
2. Sedentary lifestyle
3. Obesity
4. DM
5. Family History

Clinical Manifestation
• Consciousness, pulse, blood pressure are lost immediately.
• Ineffective Respiratory gasping occur.
• Dilation of pupils within 45 seconds.
• Seizures
• Risk for irreversible brain damage and death.

Emergency Management:
Cardiopulmornary Resuscitation

Cardiopulmonary resuscitation (CPR) provides blood flow to vital organs

until effective circulation can be re-established. The ABCDs of basic CPR are
airway, breathing, circulation, and defibrillation. Once loss of consciousness has
been established, the resuscitation priority for the adult in most cases is placing a
phone call to activate the code team or the emergency medical system (EMS).
Exceptions to this include near drowning, drug or medications overdose, and
respiratory arrest situations, for which 2 minutes of CPR should be performed
before activating the EMS. Because the underlying cause of arrest in infant or
child is usually respiratory, the priority is to begin CPR and then activate the EMS
after 2 minutes of CPR. Because the care of the pediatric patient is
individualized, the following discussion on the care of a cardiac arrest patient
applies mainly to adults.

The ABCD’s of basic cardiopulmonary resuscitation are consists of the following

steps:

1.Airway- Maintaning an open airway.

2.Breathing- Providing artificial ventilation by rescue breathing.
3.Circulation- Promoting artificial circulation by external cardiac compression;
administer medication therapy (eg, epinephrine for asytole)
4.Defibrillation- Restoring the heartbeat.

If the patient is already being monitored or is immediately placed on the

monitor using the multifunction pads or the quick-look paddles (found on most
defibrillators) and the ECG shows ventricular tachycardia or ventricular
fibrillation, immediate defibrillation rather than CPR is the treatment of choice. In
this scenario, CPR is performed initially only if the defibrillator is not immediately
available. The survival rate decreases for every minute that defibrillation is
delayed.

Treatments and drugs

Sudden cardiac arrest requires immediate action for survival.

CPR
Immediate cardiopulmonary resuscitation (CPR) is critical to treating sudden
cardiac arrest. By maintaining a flow of oxygen-rich blood to the body's vital
organs, CPR can provide a vital link until more advanced emergency care is
available. A quick primer on CPR follows below.

If you don't know CPR but someone collapses unconscious near you, call
emergency medical help. Then, if the person isn't breathing normally,
immediately begin pushing hard and fast on the person's chest — about
two compressions a second (100 per minute), allowing the chest to fully
rise between compressions. Do this until an automated external
defibrillator (AED) becomes available or emergency personnel arrive.

To perform CPR:

• Is the person conscious or unconscious?

• If the person appears unconscious, tap or shake his or her shoulder and
ask loudly, "Are you OK?"
• If the person doesn't respond and two people are available, one should
call the local emergency number and one should begin CPR.
• If you're alone and have immediate access to a telephone, the local
emergency number before beginning CPR — unless you think the person
has become unresponsive because of suffocation (such as from
drowning); in this special case, begin CPR for one minute and then call
emergency medical help.
• If you're alone and rescuing a child, perform CPR for two minutes before
calling emergency help or using an AED.
• If an AED is immediately available, deliver one shock if advised by the
device, then begin CPR.
• Gently tilt the head back and lift the chin up to open the airway.
• Quickly check for normal breathing, taking no more than 10 seconds.
• Pinch the nostrils shut and give the first rescue breath — lasting one
second — and watch to see if the chest rises. If it does rise, give the
second breath. If the chest doesn't rise, repeat the head-tilt, chin-lift
maneuver and then give the second breath.
• Start chest compressions by putting the heel of one hand in the center of
the person's chest and covering the first hand with the other hand.
Keeping your elbows straight, use your upper body weight to push down
 hard and fast on the person's chest, about two compressions a second.
For a child, you may need to use only one hand.
• After 30 compressions, give two more rescue breaths, making sure the
chest rises after a breath.
• If a child has not begun moving after five cycles (about two minutes) and
an AED is available, apply it and follow the prompts. Administer one shock
if so advised, then resume CPR — starting with chest compressions — for
two more minutes before administering a second shock. If you're not
trained to use an AED, an emergency medical help operator may be able
to guide you in its use.
• Continue CPR until the person recovers consciousness and is breathing
normally or until emergency medical personnel take over.

Defibrillation
Advanced care for ventricular fibrillation, a type of arrhythmia that can cause
sudden cardiac arrest, typically includes delivery of an electrical shock through
the chest wall to the heart. The procedure, called defibrillation, momentarily stops
the heart and the chaotic rhythm. This often allows the normal heart rhythm to
resume.

The shock may be administered by emergency personnel or by a trained citizen if

a public-use defibrillator, the device used to administer the shock, is available. If
you're not trained to use an AED, an emergency medical help operator may be
able to guide you in its use. Trained staff members at many public places are
able to provide and use an AED.

Defibrillators are available in a small, portable form and come with built-in
automated instructions to ensure proper use. They're programmed to recognize
ventricular fibrillation and send a shock only when it's appropriate. These
portable defibrillators are available in an increasing number of public places,
including airports, shopping malls, casinos, health clubs, and community and
senior citizen centers.

Prevention

There's no sure way to know your risk of cardiac arrest, so reducing your risk is
the best strategy. Steps to take include regular checkups, screening for heart
disease, and living a heart-healthy lifestyle with the following approaches:

• Don't smoke, and use alcohol in moderation (no more than one to two
drinks a day).
• Eat a nutritious, balanced diet.
• Stay physically active.
If you know you have heart disease or conditions that make you more vulnerable
to an unhealthy heart, your doctor may recommend that you take appropriate
steps to improve your health, such as taking medications for high cholesterol or
carefully managing diabetes.

In some people with a known high risk of cardiac arrest — such as those with a
heart condition — doctors may recommend anti-arrhythmic drugs or an
implantable cardioverter-defibrillator (ICD) as primary prevention.

If you have a high risk of cardiac arrest, you may also wish to consider
purchasing an automated external defibrillator (AED) for home use. Before
purchasing one, discuss the decision with your doctor; the devices can be
expensive and aren't always covered by health insurance.
Cardiac arrest in children

Cardiac arrest is rare in children and usually happens because breathing has
been cut off rather than because of heart problems. Health professionals need to
be especially careful when reviving children in cardiac arrest because the
medication used to revive them can also cause problems.
In children, cardiac causes of sudden cardiac arrest are much less common.
Instead, predominant causes include trauma, poisoning, and various respiratory
disorders (eg, airway obstruction, smoke inhalation, drowning, infection, sudden
infant death syndrome).

Anatomy

Airway: Upper airway anatomy is different in children. The head is large with a
small face, mandible, and the neck is relatively short. The tongue is large relative
to the mouth, and the larynx lies higher in the neck and is angled more anteriorly.
The epiglottis is long, and the narrowest portion of the trachea is inferior to the
vocal cords at the cricoid ring, allowing the use of uncuffed endotracheal tubes.
In younger children, a straight laryngoscope blade generally allows better
visualization of the vocal cords than a curved blade, since the larynx is more
anterior and the epiglottis is more floppy and redundant.

Diagnosis and Treatment

In children, the presenting rhythm is typically Brady arrhythmia, however, about

15 to 20% of children present with ventricular tachycardia or fibrillation. Thus, the
need for rapid defibrillation should be considered in any child with sudden cardiac
arrest not preceded by respiratory symptoms. Not as much is known about care
for children who experience cardiac arrest, but critical elements include
managing temperature, glucose, blood pressure, ventilation and cardiac output.
Survival is higher in hospitals with specialized pediatric staff.

Equipment and environment

Size-variable equipment includes defibrillator paddles or electrode pads, masks,
ventilation bags, airways, laryngoscope blades, endotracheal tubes, suction
catheters. Weight should be measured rather than guessed;
CPR in Infants and Children
Bradycardia in a distressed child is a sign of impending cardiac arrest. Neonates,
infants, and young children are more likely to develop bradycardia from
hypoxemia, whereas older children initially tend to have tachycardia. An infant or
child with a heart rate < 60/min and signs of poor perfusion that do not rise with
ventilatory support should have cardiac compressions

Side-by-side thumb placement for chest compressions is preferred for neonates

and small infants whose chest can be encircled. Thumbs should overlap if used
in very small neonates. B: Two fingers are used for infants. Fingers should be
maintained in the upright position during compression. For neonates, this
technique will result in too low a position, ie, at or below the xiphoid; the correct
position is just below the nipple line. C: Hand position for chest compression for a
child.

After adequate oxygenation and ventilation, epinephrine is the drug of choice.