D-Ners Weblog: Our Menu- Cardiac Arrest Management

Cardiac Arrest Management in Our Experience

Common cause of patient dead in our working area is cause by cardiac arrest, and mostly the common cause of cardiac arrest is unknown. Whatever cause of cardiac arrest, arrest is arrest and safe life action is our commitment.

Learn from case to case of cardiac arrest, what should we do better to improve our action, to safe our patient (possibility). The principles of cardiac arrest management as my experiences are:

Ø Control our self, don’t panic

Ø Organize the team

Ø Learn from experience

Ø Learn from latest theory/guideline

Ø Discussion, and

Ø Follow the procedure, do we have it ? if no follow the latest guideline AJA.

Mostly all of references urges the public to be prepared for cardiac emergencies:
Know the warning signs of cardiac arrest. During cardiac arrest a victim loses consciousness, stops normal breathing and loses pulse and blood pressure.
Call Emergency in your area immediately to access the emergency medical system if you see any cardiac arrest warning signs.
Give cardiopulmonary resuscitation (CPR) to help keep the cardiac arrest victim alive until emergency help arrives. CPR keeps blood and oxygen flowing to the heart and brain until defibrillation can be administered.

How is our cardiac work?

What is cardiac arrest?
Cardiac arrest is the sudden, abrupt loss of heart function. The victim may or may not have diagnosed heart disease. It's also called sudden cardiac arrest or unexpected cardiac arrest. Sudden death (also called sudden cardiac death) occurs within minutes after symptoms appear.
A cardiac arrest, also known as cardiorespiratory arrest, cardiopulmonary arrest or circulatory arrest, is the abrupt cessation of normal circulation of the blood due to failure of the heart to contract effectively during systole.

"Arrested" blood circulation prevents delivery of oxygen to all parts of the body. Cerebral hypoxia, or lack of oxygen supply to the brain, causes victims to lose consciousness and to stop normal breathing. Brain injury is likely if cardiac arrest is untreated for more than 5 minutes, although new treatments such as induced hypothermia have begun to extend this time.To improve survival and neurological recovery immediate response is paramount.

Cardiac arrest is a medical emergency that, in certain groups of patients, is potentially reversible if treated early enough (See Reversible Causes, below). When unexpected cardiac arrest leads to death this is called sudden cardiac death (SCD).The primary first-aid treatment for cardiac arrest is cardiopulmonary resuscitation (commonly known as CPR) to provide circulatory support until availability of definitive medical treatment, which will vary dependant on the rhythm the heart is exhibiting, but often requires defibrillation.

Cardiac arrest refers to a sudden, profound disturbance in the heart’s rhythm that causes the heart to stop beating completely or slow to the point where the life is unsustainable. Cardiac arrest is not the same as a heart attack. A heart attack, while potentially life threatening, usually offers a short period of time in which treatment can save the person’s life.

What causes cardiac arrest?

The most common underlying reason for patients to die suddenly from cardiac arrest is coronary heart disease. Most cardiac arrests that lead to sudden death occur when the electrical impulses in the diseased heart become rapid (ventricular tachycardia) or chaotic (ventricular fibrillation) or both. This irregular heart rhythm (arrhythmia) causes the heart to suddenly stop beating. Some cardiac arrests are due to extreme slowing of the heart. This is called bradycardia.

Other factors besides heart disease and heart attack can cause cardiac arrest. They include respiratory arrest, electrocution, drowning, choking and trauma. Cardiac arrest can also occur without any known cause.

Cardiac arrest must be treated immediately to avoid sudden cardiac death (death that results from cardiac arrest). Unfortunately, most people (85 percent) who experience cardiac arrest cannot get help fast enough. Those who survive the event are said to have lived through an “aborted” sudden cardiac death.

Cardiac arrest is most often caused by ventricular fibrillation, a condition in which the heart’s lower chambers quiver rather than pump blood. Ventricular fibrillation is usually accompanied by existing heart disease, especially coronary artery disease and previous heart attack. According to the American Heart Association, 90 percent of adults who succumb to cardiac arrest have two or more narrowed coronary arteries. Moreover, heart attack survivors have up to six times the rate of sudden cardiac death compared to the general population. In some rare cases, cardiac arrest can be provoked by recreational drug use or trauma.

Although there is some confusion in terms of recoding deaths due to cardiac arrest, it is estimated that about 330,000 Americans die every year due to cardiac arrest. The overwhelming majority of these are caused by ventricular fibrillation.

Can cardiac arrest be reversed?

Brain death and permanent death start to occur in just 4 to 6 minutes after someone experiences cardiac arrest. Cardiac arrest can be reversed if it's treated within a few minutes with an electric shock to the heart to restore a normal heartbeat. This process is called defibrillation. A victim's chances of survival are reduced by 7 to 10 percent with every minute that passes without CPR and defibrillation. Few attempts at resuscitation succeed after 10 minutes.

How many people survive cardiac arrest?

No statistics are available for the exact number of cardiac arrests that occur each year. It's estimated that more than 95 percent of cardiac arrest victims die before reaching the hospital. In cities where defibrillation is provided within 5 to 7 minutes, the survival rate from sudden cardiac arrest is as high as 30–45 percent.

What can be done to increase the survival rate?

Early CPR and rapid defibrillation combined with early advanced care can result in high long-term survival rates for witnessed cardiac arrest. For instance, in June 1999, automated external defibrillators (AEDs) were mounted 1 minute apart in plain view at Chicago's O'Hare and Midway airports. In the first 10 months, 14 cardiac arrests occurred, with 12 of the 14 victims in ventricular fibrillation. Nine of the 14 victims (64 percent) were revived with an AED and had no brain damage.

If bystander CPR was initiated more consistently, if AEDs were more widely available, and if every community could achieve a 20 percent cardiac arrest survival rate, an estimated 40,000 more lives could be saved each year. Death from sudden cardiac arrest is not inevitable. If more people react quickly by calling emergency team and performing CPR, more lives can be saved.

Remember our last cardiac arrest case happened in our area, patient survive after early CPR and ALS done, and other cardiac arrest case brought to our facility after 20 minutes CPR and ALS done, patient’s pulse was present and VS taken reading in normal range. Fabulous, verrrryyyy rarely case.

What is the prevention?

Prevention of cardiac arrest and sudden cardiac death is aimed at controlling underlying heart disease. Experts generally recommend that people make lifestyle changes to prevent the conditions that could trigger cardiac arrest, including atherosclerosis, which is the leading cause of coronary artery disease. Lifestyle changes may include losing weight, reducing LDL cholesterol levels, eating a heart-healthy diet and getting adequate exercise. When warranted, experts also recommend medical treatment of any underlying conditions, which may involve taking medications and/or having surgery (e.g., placing an implantable defibrillator into the patient’s