7.11: Adult Cardiac Arrest
- Page ID
- 59714
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\(\newcommand{\avec}{\mathbf a}\) \(\newcommand{\bvec}{\mathbf b}\) \(\newcommand{\cvec}{\mathbf c}\) \(\newcommand{\dvec}{\mathbf d}\) \(\newcommand{\dtil}{\widetilde{\mathbf d}}\) \(\newcommand{\evec}{\mathbf e}\) \(\newcommand{\fvec}{\mathbf f}\) \(\newcommand{\nvec}{\mathbf n}\) \(\newcommand{\pvec}{\mathbf p}\) \(\newcommand{\qvec}{\mathbf q}\) \(\newcommand{\svec}{\mathbf s}\) \(\newcommand{\tvec}{\mathbf t}\) \(\newcommand{\uvec}{\mathbf u}\) \(\newcommand{\vvec}{\mathbf v}\) \(\newcommand{\wvec}{\mathbf w}\) \(\newcommand{\xvec}{\mathbf x}\) \(\newcommand{\yvec}{\mathbf y}\) \(\newcommand{\zvec}{\mathbf z}\) \(\newcommand{\rvec}{\mathbf r}\) \(\newcommand{\mvec}{\mathbf m}\) \(\newcommand{\zerovec}{\mathbf 0}\) \(\newcommand{\onevec}{\mathbf 1}\) \(\newcommand{\real}{\mathbb R}\) \(\newcommand{\twovec}[2]{\left[\begin{array}{r}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\ctwovec}[2]{\left[\begin{array}{c}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\threevec}[3]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\cthreevec}[3]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\fourvec}[4]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\cfourvec}[4]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\fivevec}[5]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\cfivevec}[5]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\mattwo}[4]{\left[\begin{array}{rr}#1 \amp #2 \\ #3 \amp #4 \\ \end{array}\right]}\) \(\newcommand{\laspan}[1]{\text{Span}\{#1\}}\) \(\newcommand{\bcal}{\cal B}\) \(\newcommand{\ccal}{\cal C}\) \(\newcommand{\scal}{\cal S}\) \(\newcommand{\wcal}{\cal W}\) \(\newcommand{\ecal}{\cal E}\) \(\newcommand{\coords}[2]{\left\{#1\right\}_{#2}}\) \(\newcommand{\gray}[1]{\color{gray}{#1}}\) \(\newcommand{\lgray}[1]{\color{lightgray}{#1}}\) \(\newcommand{\rank}{\operatorname{rank}}\) \(\newcommand{\row}{\text{Row}}\) \(\newcommand{\col}{\text{Col}}\) \(\renewcommand{\row}{\text{Row}}\) \(\newcommand{\nul}{\text{Nul}}\) \(\newcommand{\var}{\text{Var}}\) \(\newcommand{\corr}{\text{corr}}\) \(\newcommand{\len}[1]{\left|#1\right|}\) \(\newcommand{\bbar}{\overline{\bvec}}\) \(\newcommand{\bhat}{\widehat{\bvec}}\) \(\newcommand{\bperp}{\bvec^\perp}\) \(\newcommand{\xhat}{\widehat{\xvec}}\) \(\newcommand{\vhat}{\widehat{\vvec}}\) \(\newcommand{\uhat}{\widehat{\uvec}}\) \(\newcommand{\what}{\widehat{\wvec}}\) \(\newcommand{\Sighat}{\widehat{\Sigma}}\) \(\newcommand{\lt}{<}\) \(\newcommand{\gt}{>}\) \(\newcommand{\amp}{&}\) \(\definecolor{fillinmathshade}{gray}{0.9}\)Usually the main cause of adult cardiac arrest is ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) secondary to Ischaemic heart disease however in the perioperative situation the most common rhythm in cardiac arrest is asystole and common causes are drugs, vagal stimulation, hypoventilation, hypoxaemia and hypovolaemia. The treatment is different for these two causes of cardiac arrest. However, in all cases of cardiac arrest:
CALL FOR HELP
STOP ALL ANAESTHETIC AGENTS
GIVE 100% OXYGEN
ENSURE THE PATIENT IS VENTILATED
GIVE CHEST COMPRESSIONS
ATTACH DEFIBRILLATOR/MONITOR
Ventricular Fibrillation/Pulseless Ventricular Tachycardia
The single most important treatment for VF/VT is immediate defibrillation. External cardiac massage (chest compressions) will provide up to 25% of normal cardiac output and 33% of coronary blood flow and will help to maintain the heart in VF/VT.
Eventually the VF/VT will deteriorate to a non-viable rhythm. VF/VT must be treated with immediate defibrillation (if available). The chance of successful defibrillation falls by 5% each minute in VF and the rhythm degenerates to asystole in about 15 minutes.
Administer a single shock and immediately resume CPR for 2 minutes after delivery of the shock. Do not delay in commencing CPR to assess the rhythm. During this time check the electrodes, check the airway is clear and the patient is receiving 100%oxygen, and give adrenaline 1mg every 3 to 5 minutes and correct reversible causes. If further shocks are required then a single shock regime should be used. Continue this sequence of treatment until resuscitation is successful or a decision to stop is made.If the arrest has been witnessed by a rescuer then a stacked shock regimen should be administered. A maximum of thee shocks should be given, with the paddles or pads remaining on the chest wall. The defibrillator is immediately recharged and the rhythm checked after each shock.
Asystole or Pulseless Electrical Activity (PEA)
If PEA is the initial rhythm there is a chance that there is a treatable cause. The anesthetist must check that VF/VT is not present, commence CPR, give adrenaline 1mg every 3 minutes and immediately think about the cause of the PEA/Asystole. The most common cause is hypovolaemia. The other causes are:
Hypovolaemia
Hypoxaemia
Hypo or hyperkalaemia, hypermagnesaemia, hypercalcaemia
Hypothermia, hyperthermia
Tension pneumothorax
Tamponade (trauma, renal failure, malignancy)
Thromboembolic, pulmonary embolus
Toxicity (anaphylaxis, drug overdose)
